Surname/ Family First Name Name Professional status Professional working relationship with applicant How long have you known the applicant? (Years) (Months) Address Postcode: Phone number for queries Email address For queries Declaration by Supporting Signatory I, the undersigned, confirm that: - I am over 18 years old I am not related to the applicant by birth or marriage I am not in a personal relationship with the applicant nor live at the same address I have reviewed the special circumstances application that has been submitted I am prepared to be contacted by the panel to discuss the information provided if necessary I confirm that information the applicant named above is correct and I support the applicant in their application for consideration for pre-allocation to a local foundation school on the grounds of special circumstances due to a medical condition/disability.
Surname/ Family Name First Name Professional status Professional working relationship with applicant How long have you known the applicant? (Years) (Months) Address Postcode: Phone number for queries Email address For queries Declaration by Supporting Signatory I, the undersigned, confirm that: - I am over 18 years old I am not related to the applicant by birth or marriage I am not in a personal relationship with the applicant nor live at the same address I have reviewed the special circumstances application that has been submitted I am prepared to be contacted by the panel to discuss the information provided if necessary I confirm that information the applicant named above is correct and I support the applicant in their application for consideration for pre-allocation to a local foundation school on the grounds of special circumstances due to a medical condition/disability.
Criterion%203%20Special%20Circumstances%20Application%20Form.docx