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Back Preview Get SCROLL to use this template| Name | Text of question | Type of answer | Further notes | Data source | Mandatory? |
|---|---|---|---|---|---|
| pupil_first_name | Forename | Text (single-line) | CBDS | Yes | |
| pupil_middle_name | Middle name(s) | Text (single-line) | Optional | CBDS | |
| pupil_pref_name | Preferred Name | Text (single-line) | Optional | CBDS | |
| pupil_surname | Surname(s) | Text (single-line) | As stated on Birth Certificate. | CBDS | Yes |
| pupil_dob | Date of Birth (dd/mm/yyyy) | Date | CBDS | Yes | |
| pupil_year_entry | Year of proposed entry | List of choices | CBDS | Yes | |
| pupil_gender | Is the child a...? | List of choices | CBDS | Yes | |
| pupil_line1_address | House number/name and street | Text (single-line) | CBDS | Yes | |
| pupil_line2_address | Name of city or town | Text (single-line) | Optional | CBDS | |
| pupil_postcode | Postcode | Text (single-line) | Yes | ||
| pupil_home_tel | Home telephone number | Text (single-line) | Yes | ||
| pupil_residence | Which Local Authority does the child live in? | List of choices | Local Authority to which Council Tax is paid. | CBDS | Yes |
| pupil_lives_with | Who does the child live with at this address? | List of choices | Please select all that apply. You will be asked about any other addresses later in this form. | Yes | |
| pupil_place_of_birth | Please select the child's place of birth from the list below. | List of choices | CBDS | Yes | |
| pupil_nationality | Please select the child's nationality from the list below. | List of choices | If the child holds multiple nationalities, including British, please select British (United Kingdom) from this list. | CBDS | Yes |
| pupil_arrival_in_uk | Please enter the date the child arrived in the UK. (dd/mm/yyyy) | Date | CBDS | Yes | |
| pupil_asylum | Is the child an asylum seeker? | List of choices | CBDS | Yes | |
| pupil_refugee | Is the child a refugee? | List of choices | CBDS | Yes | |
| pupil_nhs_number | Child's NHS number | Text (single-line) | Found on the child's medical card or obtained from your doctor. | Yes | |
| pupil_medical_condition | Does the child suffer from ANY medical condition, or take medication for any problem? | List of choices | If you tick any of the following, a letter from your GP or hospital consultant will be required to keep on the child's file.@| Select all that apply | Yes | |
| pupil_meds | Does your child carry any of the following? | List of choices | Select all that apply | Yes | |
| pupil_diet_needs | Does the child have any special dietary needs? | List of choices | Yes | ||
| pupil_medical_support | Does the child receive any paramedical support? | List of choices | These are services which supplement and support medical work but do not require a fully qualified doctor. | Yes | |
| pupil_medical_support_oth | Please specify other: | Text (single-line) | |||
| doctor_practice_name | Name of the medical practice where the child is registered. | Text (single-line) | Yes | ||
| doctor_name | Doctor's name | Text (single-line) | Inclusive of first name and surname. | Yes | |
| doctor_practice_line1_address | Building name/number and street | Text (single-line) | Yes | ||
| doctor_practice_line2_address | Name of city or town | Text (single-line) | Optional | ||
| doctor_practice_postcode | Postcode | Text (single-line) | Yes | ||
| doctor_practice_tel_number | Telephone number | Text (single-line) | Yes | ||
| emergency_consent | Emergency consent | List of choices | Do you give consent for the school to act on your behalf in case of an accident or emergency? | Yes | |
| pupil_first_language | Child's first language | List of choices | A language that a child is exposed to during early development and continues to be exposed to in the home or in the community.@|@|Note: A child exposed to more than one language (including English) during early development, is deemed to have a first language other than English, irrespective of their proficiency in English. | CBDS | Yes |
| pupil_other_language1 | Other language that the child is exposed to at home from the list below. | List of choices | CBDS | Yes | |
| pupil_other_language2 | If applicable, please select another language that the child is exposed to at home from the list below. | List of choices | CBDS | ||
| pupil_other_language3 | If applicable, please select another language that the child is exposed to at home from the list below. | List of choices | CBDS | ||
| pupil_in_care | Is the child, or has the child previously been, subject to a Local Authority Care Order? | List of choices | ie a looked after child | CBDS | Yes |
| pupil_in_care_local_authority | Please provide the name of the Local Authority | List of choices | CBDS | Yes | |
| pupil_in_care_social_worker | Social Worker’s Name | Text (single-line) | Inclusive of title, first name and surname. | CBDS | Yes |
| pupil_in_care_local_authority_date | Start date (dd/mm/yyyy) | Date | CBDS | Yes | |
| pupil_sen_statement | Does the child have a Statement of Special Educational Needs? | List of choices | CBDS | Yes | |
| pupil_sen_school | Please specify school named in the Statement | Text (single-line) | Yes | ||
| pupil_sen_local_authority | Name of the Local Authority | List of choices | CBDS | Yes | |
| pupil_sen_officer | Case Officer’s Name | Text (single-line) | Inclusive of title, first name and surname. | Yes | |
| pupil_free_school_transport | Does the Local Authority provide free school transport? | List of choices | Yes | ||
| pupil_free_school_meals | Is the child eligible for free schools meals? | List of choices | CBDS | Yes | |
| pupil_religion | Religion of the child. | List of choices | Yes | ||
| pupil_ethnicity | Please study the list below and tick one box to indicate the ethnic background of the child. | List of choices | Any information you provide will be used solely to compile statistics on the school careers and experiences of pupils from different ethnic backgrounds, to help ensure that all pupils have the opportunity to fulfil their potential. These statistics will not allow individual pupils to be identified. From time to time the information will be passed on to the Local Education Authority and the Department for Education (DfE) to contribute to local and national statistics. The information will also be passed on to future schools, to save it having to be asked for it again. | CBDS | Yes |
| adults_names | Please write down the name of up to four adult contacts for the child. | Please enter the names in order of contact priority. The first person you enter will be the primary contact for all correspondence and must have parental responsibility. | |||
| adult1_parentalresp | Primary contact: Does this person have parental responsibility? | List of choices | CBDS | Yes | |
| adult1_relationship | Relationship to pupil | List of choices | CBDS | Yes | |
| adult1_title | Title | List of choices | CBDS | Yes | |
| adult1_forename | Forename | Text (single-line) | CBDS | Yes | |
| adult1_surname | Surname | Text (single-line) | CBDS | Yes | |
| adult1_mobile_number | Mobile number | Text (single-line) | CBDS | Yes | |
| adult1_email | Text (single-line) | Yes | |||
| adult1_same_address_as_pupil | Is home address the same as the child's home address? | List of choices | CBDS | Yes | |
| adult1_line1_address | House number/name and street | Text (single-line) | CBDS | Yes | |
| adult1_line2_address | Name of city or town | Text (single-line) | Optional | CBDS | |
| adult1_postcode | Postcode | Text (single-line) | Yes | ||
| adult1_home_tel | Home telephone number | Text (single-line) | Yes | ||
| adult1_employment | Is this contact in employment? | List of choices | Yes | ||
| adult2_parentalresp | Second contact: does this person have parental responsibility? | List of choices | CBDS | Yes | |
| adult2_relationship | Relationship to pupil | List of choices | CBDS | Yes | |
| adult2_title | Title | List of choices | CBDS | Yes | |
| adult2_forename | Forename | Text (single-line) | CBDS | Yes | |
| adult2_surname | Surname | Text (single-line) | CBDS | Yes | |
| adult2_same_address_as_pupil | Is home address the same as the child's home address? | List of choices | CBDS | Yes | |
| adult2_mobile_number | Mobile number | Text (single-line) | Yes | ||
| adult2_email | Text (single-line) | Yes | |||
| adult2_line1_address | House number/name and street | Text (single-line) | CBDS | Yes | |
| adult2_line2_address | Name of city or town | Text (single-line) | Optional | CBDS | |
| adult2_postcode | Postcode | Text (single-line) | Yes | ||
| adult2_home_tel | Home telephone number | Text (single-line) | Yes | ||
| adult2_employment | Is this contact in employment? | List of choices | Yes | ||
| adult3_parentalresp | Third contact: does this person have parental responsibility? | List of choices | CBDS | Yes | |
| adult3_relationship | Relationship to pupil | List of choices | CBDS | Yes | |
| adult3_title | Title | List of choices | CBDS | Yes | |
| adult3_forename | Forename | Text (single-line) | CBDS | Yes | |
| adult3_surname | Surname | Text (single-line) | CBDS | Yes | |
| adult3_same_address_as_pupil | Is home address the same as the child's home address? | List of choices | CBDS | Yes | |
| adult3_mobile_number | Mobile number | Text (single-line) | Yes | ||
| adult3_email | Text (single-line) | Yes | |||
| adult3_line1_address | House number/name and street | Text (single-line) | CBDS | Yes | |
| adult3_line2_address | Name of city or town | Text (single-line) | Optional | CBDS | |
| adult3_postcode | Postcode | Text (single-line) | Yes | ||
| adult3_home_tel | Home telephone number | Text (single-line) | Yes | ||
| adult3_employment | Is this contact in employment? | List of choices | Yes | ||
| adult4_parentalresp | Fourth contact: does this person have parental responsibility? | List of choices | CBDS | Yes | |
| adult4_relationship | Relationship to pupil | List of choices | CBDS | Yes | |
| adult4_title | Title | List of choices | CBDS | Yes | |
| adult4_forename | Forename | Text (single-line) | CBDS | Yes | |
| adult4_surname | Surname | Text (single-line) | CBDS | Yes | |
| adult4_same_address_as_pupil | Is home address the same as the child's home address? | List of choices | CBDS | Yes | |
| adult4_mobile_number | Mobile number | Text (single-line) | Yes | ||
| adult4_email | Text (single-line) | Yes | |||
| adult4_line1_address | House number/name and street | Text (single-line) | CBDS | Yes | |
| adult4_line2_address | Name of city or town | Text (single-line) | Optional | CBDS | |
| adult4_postcode | Postcode | Text (single-line) | Yes | ||
| adult4_home_tel | Home telephone number | Text (single-line) | Yes | ||
| adult4_employment | Is this contact in employment? | List of choices | Yes | ||
| home_school | Is the child currently educated at home? | List of choices | Yes | ||
| current_school | Is the child presently attending school? | List of choices | Yes | ||
| current_school_name | Name of the school the child attends at present. | Text (single-line) | CBDS | Yes | |
| current_school_line1_address | Building number/name and street | Text (single-line) | CBDS | Yes | |
| current_school_line2_address | Name of city or town | Text (single-line) | Optional | CBDS | |
| current_school_postcode | Postcode | Text (single-line) | Yes | ||
| current_school_tel | Telephone number | Text (single-line) | Yes | ||
| current_school_name_head | Name of headteacher | Text (single-line) | Inclusive of title, first name and surname | CBDS | Yes |
| current_school_type | What type of school is it? | List of choices | CBDS | Yes | |
| previous_school | Has the child attended any school in the past? | List of choices | Yes | ||
| previous_school1_name | Name | Text (single-line) | CBDS | Yes | |
| previous_school1_line1_address | Building number/name and street | Text (single-line) | CBDS | Yes | |
| previous_school1_line2_address | Name of city or town | Text (single-line) | Optional | CBDS | |
| previous_school1_postcode | Postcode | Text (single-line) | Yes | ||
| previous_school1_start | Start date (dd/mm/yyyy) | Date | CBDS | Yes | |
| previous_school1_stop | Leaving date (dd/mm/yyyy) | Date | CBDS | Yes | |
| previous_school1_reason_stop | Reason for leaving | Text (multi-line) | Yes | ||
| previous_school2_name | Name | Text (single-line) | CBDS | Yes | |
| previous_school2_line1_address | Building number/name and street | Text (single-line) | CBDS | Yes | |
| previous_school2_line2_address | Name of city or town | Text (single-line) | Optional | CBDS | |
| previous_school2_postcode | Postcode | Text (single-line) | Yes | ||
| previous_school2_start | Start (dd/mm/yyyy) | Date | CBDS | Yes | |
| previous_school2_stop | Leaving date (dd/mm/yyyy) | Date | CBDS | Yes | |
| previous_school2_reason_stop | Reason for leaving | Text (multi-line) | Yes | ||
| siblings_at_school | Has the child got any siblings at our school? | List of choices | Yes | ||
| sibling1_first_name | Forename | Text (single-line) | Yes | ||
| sibling1_surname | Surname(s) | Text (single-line) | Yes | ||
| sibling1_gender | Gender | List of choices | Yes | ||
| sibling1_school_year | School year of sibling #1 | List of choices | Yes | ||
| sibling2_first_name | Forename | Text (single-line) | Yes | ||
| sibling2_surname | Surname(s) | Text (single-line) | Yes | ||
| sibling2_gender | Gender | List of choices | Yes | ||
| sibling2_school_year | School year of sibling #2 | List of choices | Yes | ||
| sibling3_first_name | Forename | Text (single-line) | Yes | ||
| sibling3_surname | Surname(s) | Text (single-line) | Yes | ||
| sibling3_gender | Gender | List of choices | Yes | ||
| sibling3_school_year | School year of sibling #3 | List of choices | Yes | ||
| additional_info | Please use this space to state reason(s) for applying for a school place in year. | Text (multi-line) | Yes | ||
| declaration_adult1 | I confirm by ticking the box below that all the information given in this form is true to the best of my knowledge. | List of choices | Yes | ||
| declaration_adult2 | I confirm by ticking the box below that all the information given in this form is true to the best of my knowledge. | List of choices | Yes | ||
| declaration_adult3 | I confirm by ticking the box below that all the information given in this form is true to the best of my knowledge. | List of choices | Yes | ||
| declaration_adult4 | I confirm by ticking the box below that all the information given in this form is true to the best of my knowledge. | List of choices | Yes |