Parental Initial Enquiry Form

Full Name of Potential Student

Potential student's preferred name

Address

Date of birth

Name of parent carer

Email address

Address, if different from above

Home phone number

Mobile phone number

Preferred means of contact Preferred means of contact Call to home phone Call to mobile phone Text to mobile phone Email Post

Contact details for any other person with parental responsibility (optional)

Potential student's current school year

Name and address of potential student's current or most recent educational establishment

Is the student currently receiving Special Educational Needs (SEN) support? Please provide details.

Does the student have an Education, Health and Care Plan (EHCP)? Please provide details.

Please provide an overview of the student’s additional needs and any diagnoses.

Do you consent to Wider Ambition responding to local authority consultations in relation to a placement for your child? Do you consent to Wider Ambition responding to local authority consultations in relation to a placement for your child? Yes No

Where more than one person has parental responsibility, they should both provide consent where possible.

By submitting this form, you agree to the following:

I accept the Admissions Policy and the Data Protection Policy for Wider Ambition, which I can access on the policies page of this site.

I give consent for personal information relating to me or to the above potential student to be processed accordingly.

I understand that if I do not want any personal information to be shared with the third parties listed in the Admissions Policy, I must notify Wider Ambition in writing at the earliest opportunity.

If my child is over 13 years old, they have given their consent for me to include their personal data in this form.