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Student Application

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Student Application

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Fields marked with an * are required

Part 1

Student Full Name *

Gender *

Male
Female

Address *

Post Code *

Date of Birth *

Age *

Landline *

Parents/Carers Name

Father *

Mother *

Parents/Carers Contact Number

Home

Work *

E-mail *

Emercency Contact

Name *

Address (Emergency) *

Emergency Contact Number

Home (Emergency) *

Work (Emergency) *

Part 2

Brief medical history: *

Does your child have any Allergies? *

Does your child have any special Dietary Needs? *

Name & Address of Doctor: *

Doctors Telephone Number: *

Language spoken at home: *

Brief madrasah history *

Name of School/s Attended *

Ethnicity *

Indian
Pakistani
Other

Other (please state)

Please use the space below for any other Additional Information that you think may be relevant

ALL INFORMATION GIVEN WILL BE DEALT IN STRICT CONFIDENCE AND UNDER THE DATA PROTECTION ACT 2000.

Our Vision

Our vision: to provide every individual, with the opportunity and enabling environment to grow and flourish to achieve their full potential. Our mission

To meet the varying needs (including religious and cultural needs) of individuals with SEND (special educational needs and disabilities) using a holistic approach.

To provide a nurturing environment that is happy, safe and stimulating through a team of highly skilled specialist staff

To ensure it is a beacon of excellence and leading force for SEND within the local and extended community (raising awareness, and delivering training and development programmes).

Working in partnership as part of a multi-agency network to meet the needs of individuals with SEND and their families.

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