APPLICATION FORM
Religions and Philosophies Masterclass
(Wednesday 8th November, 1.00pm – 4.00pm)
STUDENT DETAILS (please print clearly)
Full Name ……………………………………………………………………………………………….
Date of Birth…………………………………………………… Male / Female
Address (including postcode)………………………………………………………………………..
……………………………………………………………………………………………………………………………......
Contact number…………………………………Email………………………………………………
EDUCATIONAL DETAILS
Current school / college…………………………………………………………………………………
Year group …………………………….
Subjects currently studied: ………………………………………………………………………………….
……………………………………………………………………………………………………………
School at which you took your GCSEs………………………………………………………………..
Please list your GCSE results below:
Subject / GradeSCHOOL/COLLEGE AGREEMENT
Signature of supporting teacher……………………………………..Date…………………………
Teacher name (printed) ………………………………………………………………………………
Phone number……………………………………Email………………………………………………
Please post: Sarah Tucker, WP Team, SOAS, University of London,Thornhaugh St, Russell Square, London, WC1H 0XG, OR email to
Application deadline = Wednesday 1st November 2017Please Turn Over
ADDITIONAL INFORMATION
Providing the information below will help us to ensure that places are allocated to those who will gain the most from participating in the project. If you are unsure how to answer any question, please contact
Has at least one of your parents/guardians completed
an undergraduate university degree (in the UK)?Yes/No
Have you been eligible for Free School Meals?Yes/No
Have you been in Local Authority care?Yes/No
Are you a young carer?Yes/No
Are you a refugee?Yes/No
“A person has a disability if they have a physical or mental impairment which has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities”
Given the above, do you consider yourself to have a disability?Yes/No
Which ethnic group do you identify with?
Please note that ethnic identity is self-defined; this means that only you will know if you see yourself as belonging to one of the ethnic groups listed.
White / Other Asian backgroundGypsy or Traveller / Mixed – White and Black Caribbean
Black or Black British – Caribbean / Mixed – White and Black African
Black or Black British – African / Mixed – White and Asian
Other Black background / Other mixed background
Asian or Asian British – Indian / Arab
Asian or Asian British – Pakistani / Other ethnic background
Asian or Asian British – Bangladeshi / Prefer not to say
Chinese
USE OF PERSONAL DATA
This activity is funded to promote progression to higher education (HE) by those from backgrounds currently under-represented in HE. It is therefore helpful for us to use the information in applications to evaluate the targeting of our activity. Any information will be treated in accordance with the Data Protection Act (1998).
Under the Data Protection Act (1998), you have a right to a copy of the data held about you by us, for a small fee. If you have any concerns or would like a copy of the data you have supplied directly to us, please contact .
Permission to hold and use personal data:
By submitting an application, you agree to the information provided in this form being processed by SOAS for the purposes of evaluating widening participation activities. You also agree to the data being made available to members of staff at SOAS and the Office for Fair Access (OFFA) for this purpose on the understanding that no information will be published that could identify you.
PARENT / GUARDIAN AGREEMENT
I agree to the student named above taking part in the SOAS Religions and Philosophies Masterclass:
Signed……………………………………………………………………Date…………………………
Name (printed)…………………………………………………………………………………………