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Which course are you applying for?*
- BTEC LEVEL 3 EXTENDED DIPLOMA IN PERFORMING ARTS
- GAP YEAR COURSE
Personal Details
Name*
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Date of birth*
Learning difficulties and / or disabilities?
Please inform us of any learning difficulties and / or disabilities you may need assistance with.
How did you hear about us?*
Guardian 1
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Email address*
Occupation*
Guardian 2 (Optional)
Name
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Address
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Occupation
Performing Arts Education
Please list your performing arts education
Please state any performing arts (singing, acting, dance, musical instruments) training and certificates gained. Only state the highest level achieved in any subject.
Subject Syllabus / style Years of training Most recent exam Date taken Result
Academic Education
Please list your academic education
All school examinations passed and those to be taken within the current academic year. (or where results are pending)
Subject Exam type Date taken Result
Schools Attended
Please list the schools you've attended
Include current performing arts and academic schools.
Name and address of school Entry date Leaving date
Phone
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Download the application form using the button below and then post the form to:

JACKIE PALMER ACADEMY
JACKIE PALMER STUDIOS
45-56 BRIDGE STREET
HIGH WYCOMBE
BUCKS HP11 2EL

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Subject	Syllabus / style	Years of training	Most recent exam	Date taken	Result

Name and address of school	Entry date	Leaving date