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ORT JUMP Year 12 Alternative Work Experience Application Form 2026
Name
(Required)
First
Last
Pronouns (e.g. She/Her, He/Him, They/Them, etc)
(Required)
School Email
(Required)
Mobile Number
(Required)
Personal Email
(Required)
Date of Birth
(Required)
Day
Day
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Month
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1
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Year
Year
2027
2026
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1920
Home Address
(Required)
Address Line 1
Address Line 2
City
Postcode
School/6th Form College
(Required)
Teacher Reference Name
(Required)
Teacher Reference Email
(Required)
School/6th Form College Safeguarding Lead Name
(Required)
You can find out details of the safeguarding lead from your school/6th form college office
School/6th Form College Safeguarding Lead Email
(Required)
You can find out details of the safeguarding lead from your school/6th form college office
GCSEs studied
(Required)
A Levels / BTEC (studying)
(Required)
What would you like to gain from the programme?
(Required)
Understand more about an industry
How to communicate within a professional setting
How to create a personal profile for an application
Advice on public speaking
Careers options
Networking skills
Other
Other
(Required)
Although this is a skills based programme, please give details of industries you're interested in.
Please provide information explaining who you are, your interests, aspirations and goals. Include any work experience or work skills you have to date.
(Required)
Do you have any individual needs (Would you require The ORT JUMP Alternative Work Experience Programme to be adapted for any individual needs? e.g. wheelchair access, severe allergies, etc.)
Guardian Name
(Required)
First
Last
Guardian Phone
(Required)
Guardian Email
(Required)
How did you hear about this programme?
(Required)
ORT UK website
ORT UK Facebook
ORT UK Instagram
ORT UK LinkedIn
Friend/family member
School/6th form college
Web search
Other
Consent
(Required)
I the participant, confirm that I will conduct myself in a respectful and responsible manner throughout my work placement.
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