Name: …………………………………………………………….
Application Form
Reaching Wider Summer University Monday 14 July – Friday 1 August 2014 Reaching Wider Room 5, Glyndwr Building Swansea University Singleton Park Swansea, SA2 8PP Phone: 01792 602 128 E-mail: reachingwider@swansea.ac.uk
REACHING WIDER SUMMER UNIVERSITY Widening Access to Higher Education APPLICATION FORM DEADLINE - WEDNESDAY 30 APRIL 2014 (This form is available in Welsh and in Large Print) Your Family Name / Surname:
First Name(s):
Address:
Postcode: Tel No: (including dialling code) Mobile: Email:
Date of Birth: _ _ / _ _ / _ _ _ _
Please circle:
Female / Male / Other, optionally please specify …………………………….
Name of parent / guardian / next of kin: (please specify relationship to you)
Address of parent / guardian / next of kin: (if different from your own)
Tel No: (including dialling code) Mobile:
Equal Opportunities Information Nationality: ___________________ If you are not a UK/EU national, please give your date of entry to the UK/EU: ____________________________________________________________ Are you an Asylum Seeker? Refugee? Please note that this will NOT affect your application in any way. What language/s are spoken at home? ____________________________ Ethnic origin. Please circle 1 White 6 Pakistani 11 Other background 2 Black Caribbean 7 Bangladeshi Please write in ______________ 3 Black African 8 Chinese 4 Black Other 9 Asian Other 5 Indian 10 Mixed background
Do you have any disabilities or special requirements? Please circle.
No disability
You have a social/communication impairment such as Asperger's syndrome/other autistic spectrum disorder
You are blind or have a serious visual impairment uncorrected by glasses
You are deaf or have a serious hearing impairment
You have a long standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease, or epilepsy
You have a mental health condition, such as depression, schizophrenia or anxiety disorder
You have a specific learning difficulty such as dyslexia, dyspraxia or AD(H)D
You have physical impairment or mobility issues, such as difficulty using your arms or using a wheelchair or crutches
You have a disability, impairment or medical condition that is not listed above. Please specify…………………………
EDUCATION Name of secondary school where you studied GCSEs or equivalent: Name of the school or FE College where you are studying: Name of campus: Name of tutor: When did you start studying at this When will you leave this school or school or college? college? Current year of study (e.g. Year 12/Year 13):
Qualifications Completed (examinations or assessments, including key/core skills completed or results pending): Year taken / completed
Subject
Qualifications to be taken in the future: Month and year to be Subject taken or completed
Title & grades of qualifications (eg GCSE, BTEC Entry Level/Level 1 or 2, NVQ, AS level, etc)
Title of qualification (eg GCSE, AS Level, BTEC Level 2,/ BTEC Level 3, etc)
COURSE STRUCTURE SKILLS FOR HIGHER EDUCATION As part of the course you will undertake a varied programme of workshops and projects that will equip you with the necessary skills to succeed in Higher Education. This will include writing and presentation skills, critical thinking, research and referencing skills and time management. All students also study ONE subject option. Please choose one subject module. SUBJECT OPTION – Please tick ONE box. If you are interested in two subjects please put the number 1 next to your first choice and 2 next to your second. Biological Sciences This module is aimed at students studying at least one AS or equivalent in a science subject. Business, Marketing and Leisure Management This module is aimed at students studying business, public services, sport or leisure and tourism related subjects at Level 3. Computer Science This module is aimed at students currently studying computing or ICT at Level 3, eg AS or Applied AS Level (double award), BTEC National Diploma in ICT or similar. Creative Arts This multi-disciplinary module is aimed at students studying Art & Design, Film studies, Media Studies, Photography, Creative Media or other related subjects. Engineering This module is aimed at students studying AS Maths, Physics, Design Technology or an Engineering related level 3 BTech. Health and Early Childhood Studies This module is aimed at students who are interested in the caring professions and education such as child care social work, nursing, teaching. Students do not need to have prior experience of studying these subjects. Psychology, Criminology and Law This module aims to give students a taste of studying psychology, criminology and law at HE level. Students do not need to have any prior experience of studying these subjects. Art and Design This module is aimed at students studying art related subjects at Level 3 eg AS Photography or a BTEC National Diploma in Art. NB: The precise availability of modules will depend upon student demand. If you wish to do your assessments in Welsh please tick here 
To ensure equality of opportunity the scheme is required to obtain the following information from all applicants. All information provided will be treated as strictly confidential.
a) Do you receive free meals at school/ college or an Educational Maintenance Award or an Assembly Learning Grant? i) Free School Meals
Yes
No
ii) EMA
Yes
No
Please give your EMA reference number here:…………………………………. iii) Assembly Learning Grant
Yes
No
b) Please circle who you live with mother / father / mother and father / foster carers / other (please specify) …………………………………………………….. c) If known, what is the occupation of your parents/guardians? Father/Step-father/Guardian ________________________ Mother/Step-mother/Guardian ______________________ If retired, please state occupation before retirement. If unemployed please give their most recent job title. Do any of your parents, step-parents or guardians have any higher education qualifications, such as a degree, diploma or certificate of higher education? Please specify subject and qualification. Father/Step-father/Guardian ________________________ Mother/Step-mother/Guardian ______________________
d) What type of house do you live in? (Please )
Rented
Owned
Other (Please specify) __________
How many bedrooms do you have in your house? __________________
How many brothers/sisters do you have? Brothers
________ Sisters _________
Do you have your own bedroom/room in which to study (Please ) No
Yes
Do you have a part time job? (Please ) No
Yes
(Please specify how many hours a week) _______
e) Have you been in care? Yes/No If you have spent any time in local authority care, even for one day, (this includes if you have been in public care and have lived in one or more of foster care, semi-independent living or residential care homes), please circle yes. If yes, please tell us for how long ……Years ……Months ……Weeks
REHABILITATION OF OFFENDERS ACT Have you been convicted by a court of any criminal offence for which you are still subject to a period of rehabilitation under the terms of the Rehabilitation of Offenders Act 1974? YES
NO
If you are still subject to a period of rehabilitation, please provide details of the conviction on a separate sheet.
PERSONAL STATEMENT FORM
Please write or word process a short (250 word maximum) personal statement explaining why you think that you should be considered for a place on the programme and how you think you would benefit from it. You may use the opposite page or attach a separate sheet (please put your full name at the top if attaching a separate sheet). Please note that places are limited and priority will be given to applications that relate to one or more of the access criteria below:
resident in a Communities First area in care or a care leaver receiving full EMA or FREE school meals; member of a black or minority ethnic group; have a learning or physical disability; no parental experience of Higher Education
Try and include the following information:
Why you want to come to the Summer University Which of the Access Criteria you meet (please see box above) What aspects of the Summer University most appeal to you and how you think you would benefit from the programme What subjects you would like to study at the University and any career ideas you may have Any activities you are involved in, such as sports, clubs, part-time work Anything else you wish to tell us or think we should know.
Please note that depending on the number of people who apply, you may be asked to attend a short informal interview .
PERSONAL STATEMENT
STUDENT DECLARATION I wish to apply for a place on the Reaching Wider Summer University 2014. The information I have provided on this form is accurate. Should I be offered a place on the Summer University, I agree to abide by the rules of the Summer University as appropriate. I agree to Swansea University and University of Wales Trinity Saint David processing personal data about me including data defined as sensitive (e.g. ethnic origin, health) which the University may obtain from me or other people or organisations, whilst I am applying for entry onto the Summer University or as a student of it. I agree to the processing of such data for any purpose connected with my studies or my health and safety whilst on the premises or for any other legitimate reason. Signature of applicant: _______________________ Date: ___________ Name (Block capitals): __________________________________________ Students will be normally expected to be residential unless it is not possible due to cultural reasons or other special requirements. Please indicate below. I wish to be residential
I do not wish to be residential
Reason ………………………………….
DECLARATION by parent or guardian of applicant if under the age of 18 on 14th July 2014: I agree that my son/daughter/ward may attend the Summer University at Swansea University and University of Wales Trinity Saint David and that the information they have provided is correct. Signature of parent/guardian__________________
Date___________
Name (Block capitals)_________________________________________ PHOTOGRAPHS The University may photograph/film students for publicity reasons (e.g. prospectus etc). If you DO NOT AGREE for a photograph/film of your son / daughter / ward to be used please tick the box.
APPLICATION FORM DEADLINE - WEDNESDAY 30 APRIL 2014
The information you give on this form is confidential. We will keep it secure and use it for administration. Only staff members will be able to see this information. We will use this information to send statistics to the Higher Education Statistics Agency and other course funders. These statistics will not give out people’s names or other identifying details. We will process this information under the terms of the Data Protection Act 1998. While we cannot legally require this information, it will assist us in acting in the best interests of the young people and their teachers.
The address to send your completed application form to is: Reaching Wider Room 5, GlyndĹľr Building Swansea University Singleton Park Swansea SA2 8PP Tel: 01792 602 128 Email: reachingwider@swan.ac.uk Alternatively, hand in your application to your FE College or 6th Form contact.
If you have any queries, please do not hesitate to contact us to discuss any aspect of the programme before sending in your application.
Thank you for your interest.