APPLICATION FOR TRANSFER FROM PRIMARY TO SECONDARY SCHOOL

IN SEPTEMBER 2015

This form is for Hackney residents use only. If you live outside Hackney you must complete your Borough or County Council application
form. Please carefully read the guidance notes on the last page before completing the form. Completed forms must be returned to the address
shown at the end of the form, by 24
th
October 2014. If this form is received after the national closing date of 31
st
October 2014, it will be
treated as a late application. There is the easier option of applying on-line at: www.eadmissions.org.uk

This form should not be completed for a child who has a Statement of Special Educational Needs/Health, Care and Education Plan
you can contact an officer on 020 8820 7183 for further advice about a school transfer.

1. Childs Details

Childs
First Name(s)

Surname/
Last Name


Childs Date of
Birth
/ /
Gender Boy Girl


Childs
Home
Address




Post code:
Is the above address: Permanent? Yes No

Is the address: Social housing Owner occupier Living with a relative

Private landlord, Please provide end date of tenancy agreement ........./........./..........

(This must be the address where the child normally lives between Monday and Friday and where the child benefit is received. If this is differ-
ent from the parent/carer address, please give reasons for this. If parents share custody, this must be stated and both addresses shown).

Primary School

(Please also give address if school is outside Hackney)

2. Parents/Carers Details

Parent/Carer 1 Title (Please circle) Mr Mrs Miss Ms Other First name

Surname
Relationship
to Child
e.g father, mother

State address if
different
(If address is different from childs home address provide reasons for this)


Home Tel no. Mobile Tel E-mail Address






Parent/Carer 2 Title (Please circle) Mr Mrs Miss Ms Other First name

Surname
Relationship
to Child
E.g. father, mother


Home Tel no. Mobile Tel E-mail Address





Please turn over



Name of secondary school
Borough or County
in which school is
located
First name, surname and
date of birth of any
sibling(s) already attending
the school
Medical/social
reasons

Preference 1

Tick box
You must provide
documents to support your
Social/Medical Reasons

Preference 2

Tick box
You must provide
documents to support your
Social/Medical Reasons

Preference 3

Tick box
You must provide
documents to support your
Social/Medical Reasons

Preference 4

Tick box
You must provide
documents to support your
Social/Medical Reasons

Preference 5

Tick box
You must provide
documents to support your
Social/Medical Reasons

Preference 6

Tick box
You must provide
documents to support your
Social/Medical Reasons
Staff child Priority is applied to children of staff who work at the school /academy fulltime with at least two years continuous
employment by the academy or where the academy reasonably considers a member of staff has been recruited for a position for
which there is a demonstrable skill shortage.
Name of staff School / academy name Designation / Role Start date


4. Other information
Reasons for preferences - Please give the reasons below for your application including any relevant background information, these
might include religious, philosophical or any other reasons.
Please continue on a separate sheet if necessary.
Exceptional Medical, Social or Other Grounds
If you think that there are exceptional medical or social reasons why your child should attend a particular school, you must provide and
explanation below professionally supported by evidence (such as GP, Social work or any other agency letters). It is very important that you check
the admission criteria of each school for which you are applying to see if priority of admission can be given on this basis.

Please continue on a separate sheet if necessary.

5. Children in Care/Subject to a Child Protection Plan This includes all looked after children and
children who were previously looked after, and are now subject to an adoption, residence (child care arrangements), or special
guardianship order.
Is this child Looked After by a Local Authority
If yes, please complete below:
Is this child subject to a Child
Protection Plan (CPP)?
Local authority Social worker name Contact number
Yes No

3. Secondary School Preferences
Please write the name of up to SIX schools which you wish to apply to. You must list the schools in the order you prefer them. You
should include all state-funded schools, academies and free schools for which you wish to apply, including any schools which are outside
of Hackney. You should include the details of any sibling (brother or sister) who is currently attending the school below. Applications for
private fee-paying schools must be made separately, direct to the school.



Parents/Carers Signature

Date:
/ /


Data Protection

Information supplied will be used for registered purposes under the Data Protection Act 1998

The London Borough of Hackney is the data controller for the purpose of the data protection act 1998.

This means that the London Borough of Hackney is responsible for making decisions about how your personal data will be processed and used. Your
data will be used for the purpose of school admissions, school admissions appeals, sending you questionnaires, and assessing pupils eligibility for
various pupil benefits and services. Your data may also be used for the purpose of safeguarding children and the detection of fraud. The information you
provide will be treated confidentially at all times.




.

Checklist:
Before returning this form, please ensure that you have:

Read the accompanying notes and the secondary school admissions brochure Hackneys Secondary Schools
2015 Admissions Guide for Parents (Available at www.Learningtrust.co.uk) and/or the guide for the borough or
county council in which each school for which you are applying is located.

Checked your childs address is within the Borough of Hackney.

Completed all relevant sections of this form.

Enclosed any supporting evidence e.g. a letter from the family doctor/hospital consultant in support of any
medical or social reason for wanting a place at a particular school

Attached the relevant proofs of address detailed below (if you have changed address in the last year we
may request further evidence):


The original council Tax Bill for Year 2014/2015 or the original letter for Housing Benefit entitlement

An original utility bill received within the last two months (Gas, Electricity or Landline phone)

Completed supplementary forms MUST BE SENT DIRECTLY TO THE SCHOOL(S) CONCERNED. Please
check the admission criteria for each school for which you are applying to see if a supplementary form is
required, particularly faith based schools.






6. Declaration and Signature of Parent/Carer
I wish to apply for a place at each of the schools named in Section 3, and I have listed these schools in my order
of preference.

I certify that I am the person with parental responsibility for the child named above who lives in the Borough of
Hackney, and that the information given is true to the best of my knowledge and belief.

I understand that any false or deliberately misleading information given on this form and/or supporting information
may render this application invalid, or lead to the offer of a place being withdrawn.


GUIDANCE NOTES FOR PARENTS WHO WISH TO COMPLETE THE ATTACHED FORM
PUPILS TRANSFER FROM PRIMARY TO SECONDARY SCHOOL IN SEPTEMBER 2015
This form should not be completed in respect of a child who has a Statement of Special Educational
Needs/Education Health and Care Plan

All Hackney residents must complete this form. The national closing date is 31 October 2014, we would prefer all
completed forms returned to Hackney Learning Trust by 24
th
October 2014.

Hackney Learning Trust will process all of your preference at the same time and use the Pan-London Admissions
System to transfer any preferences outside of Hackney. Please refer to booklet Hackneys Secondary School
2015 Admissions Guide for Parents for further information go to; www.learningtrust.co.uk

All your preferences will get considered at the same time, regardless of its rank and whether the school is in another local
authority.
Section 1 Childs Details
All sections must be completed.
Section 2 Parents/Carers Details
Please ensure that the names of all responsible adults/carers are recorded on the form for the secondary school to
approach. Please note that when parents live separately, the application must be based on one address where the child
normally lives between Monday and Friday and where the child benefit is received. You should provide a letter of
explanation as to the living/care arrangements of your child if the address is different to the address that is normally used.
Hackney Learning Trust will withdraw offers of a place if it has been proven that false or misleading information has been
provided.
Section 3 Secondary School Preferences
You are entitled to name up to six secondary schools anywhere in London as your expressed preferences on this form
(except for private fee paying schools). Please ensure that you complete all the boxes that are applicable to each
preference.

Sibling Connection - It is important that you state if your child already has a brother or sister including step siblings,
(they must be living in the same household/ address between Monday to Friday) attending the preference school, as this
can give your child priority for admission.

Medical/Social reasons - Special consideration can be given to children who have a particular medical or social need.
This will need to be demonstrated by providing professionally supported documentation, and explains why this means
your child can only attend a particular school. These documents should be attached to this form or sent to us by Monday
5th January 2015.

Children of staff working at a school Some schools, as part of their criteria give priority to children of staff working in
their school. You will need to provide the member of staff details (who is the parent of the child) on the form in order to be
considered under this priority.

If applying to Cardinal Pole Catholic, Lubavitch Girls Senior Girls Jewish, The Urswick CE, Our Ladys Covent Catholic
and Yesodey Hatorah Girls Jewish Schools you must obtain a supplementary form for religious commitment. The
supplementary form must be completed by the Priest/Vicar/Pastor/Rabbi and is available directly from the secondary
schools. Completed supplementary forms must be sent directly to the school(s) concerned.

Section 4 Other information
You can provide other reasons for preferences including any relevant background information, these might include
religious or philosophical.
Section 5 Children in Care/Subject to a Child Protection
If you are a Foster Carer, looking after a child who is in public care, this must be indicated on the form. Children in this
category will be given priority of admission to the community schools in Hackney in accordance with the criteria for
admission. If previously looked after proof of this must be supplied.
Please return this form to: Admissions Team, Hackney Learning Trust, 1 Reading Lane, E8 1GQ
Contact number: 020 8820 7501/7247
RECEIPT
Receipt of application:
Your application has been received by:

......................................................................................................
(To be signed by the Admissions officer receiving the form)

Name of Child ______________________________________

Date of Birth / /
HLT Stamp