0800 783 6095


Online Application

Part 1. Personal details



Part 2. About You

Part 3. A Level Choices

Part 4. Learner Support

At Dudley Sixth we can provide additional help to many students. Please let us know if you are entitled by selecting from the options below or in the space provided.

Visual impairment
Hearing impairment
Disability affecting mobility
Other physical disability
Other medical condition (e.g., epilepsy, asthma, diabetes)
Emotional/behavioural difficulties
Mental health difficulty
Temporary disability after illness (e.g., post-viral) or accident
Profound complex disabilities
Asperger syndrome
Multiple disabilities

Moderate learning difficulty
Severe learning difficulty
Other specific learning difficulty
Autism spectrum disorder
Multiple learning difficulties

Part 5: Equality Monitoring

English / Welsh / Scottish / Northern Irish / British
Gypsy or Irish Traveller
Any Other White background

Mixed / Multiple ethnic group
White and Black Caribbean
White and Black African
White and Asian
Any Other Mixed / multiple ethnic background

Asian / Asian British
Any other Asian background

Black / African / Caribbean / Black British
Any other Black / African / Caribbean background

Other ethnic group
Any other ethnic group

Part 6: Exams to be taken

(e.g. GCSE)
Exam Board Subject
Date to be taken (M/Y)
Predicted Grade

Part 7: Exams already taken

(e.g. GCSE)
Exam Board Subject Predicted Grade

Part 8. Referee Details

Part 9. Verification

Please enter the characters you see in the image below:


Dudley Sixth collects information about learners for various administrative, academic and health & safety reasons.The Data Protection Act of 1998 requires us to obtain your consent before we can do this and, since we cannot operate Dudley Sixth without processing the information about you, we will be unable to offer you a place on any course, and will withdraw any offer already made unless you give us your consent to process your data.Therefore by submitting the Application Form you consent to Dudley Sixth processing personal data contained in the form and any other data which we may obtain from you or any other source, whilst you are a learner. You also consent to the processing of such data for any purpose connected with your studies or with your health and safety whilst on the premises or for any other legitimate and legal reason. Specifically, you consent to Dudley Sixth processing information about your race or ethnic origin as part of our Equal Opportunities Monitoring and about your physical or mental health or any medical condition you may have as part of our responsibilities for the provision of additional support and for managing our duties and obligations under the Disability Discrimination Act. Information you provide will also be passed to the Young Persons Learning Agency or the Skills Funding Agency which are registered under the Data Protection Act 1998, primarily for the collection and analysis of statistical data. However, the agencies may also share the information with other organisations for the purpose of detecting fraud. If you require any further information about the Act, please contact the Data Protection Officer at Dudley Sixth. Because the ULN is required for the administration of services within the education sector (such as the issuing of certain qualifications), individual learners are not able to opt-out of being included on the Learner Registration Service or being issued with a ULN. One potential consequence of deciding not to give permission to share the Personal Learning Record will be that you may need to provide copies of certificates or other information to verify qualifications. Individuals can opt-out of sharing participation and achievement data with those organisations listed in section 573A of the Education Act. Details of opting-out of data sharing can be found at or by telephoning the MIAP helpdesk on 0845 6022589.

If you do not wish to be contacted about courses or learning opportunities by post, email or text, please tick the box.


0800 783 6095