Marian Academy — Sixth Form Application

Tell us about the applicant. Fields marked * are required.

Surname *

Other names *

Gender *

Male Female Other

Contact number *

Email *

Home address *

Date of birth *

Age

Country of birth

Nationality

Religion

Place (Church)

Date of baptism

Church address

Previous school *

Year completed Form 5

List the subjects you wrote. You can attach the official results slip in the Documents step.

SubjectGradeYear

Number of Grade I–III passes

Pending / resit subjects

Select the subjects you wish to pursue.

Year of entry

Other subject(s)

Intended career / field of study

Any existing links to Marian Academy? (optional)

Sibling(s) attending / attended Marian Academy

Present class

Year graduated

Is a parent a past pupil of the school?

Yes No

If yes, who

Year graduated

House parent(s) were in

Referred by

Parent and guardian contact details.

Father

Surname

Other names

Address

Telephone

Occupation

Place of work

Work telephone

Nationality

Email

Mother

Surname

Other names

Address

Telephone

Occupation

Place of work

Work telephone

Nationality

Email

Guardian

Surname

Other names

Address

Telephone

Occupation

Relationship to student

Nationality

Email / work tel.

Medical and emergency information.

Name of doctor

Doctor's telephone

Permission to call your doctor / St. Joseph's Mercy Hospital in an emergency?

Yes No

Emergency contact (if neither parent can be reached)

Name

Address

Tel. (Home)

Tel. (Work)

Tel. (Cell)

Allergies or chronic illness?

Yes No

If yes, please specify

Any physical disabilities?

Yes No

If yes, please specify

Other health information the school should have

Upload a scan or photo for each document below. PDF, JPG or PNG · up to 10 MB each.

Birth Certificate * No file chosen Choose Immunization Certificate No file chosen Choose Passport Photos · up to 2 No file chosen Choose CSEC / CXC Results Slip No file chosen Choose Previous School Report / Recommendation No file chosen Choose Baptismal Certificate No file chosen Choose Other No file chosen Choose

Please read and confirm before submitting.

I agree to abide by all the regulations of the school. I undertake to pay the School fees by the first week of each term, and I understand that a term's notice (or a term's fee in lieu of notice) is required before withdrawal.

I confirm that the CSEC results and other information given above are true and complete, and I understand that admission to the Sixth Form is conditional on verification of these results.

Date of application

Signature of applicant *

Draw your signature here

Signature of parent / guardian *

Draw the signature here