Y12 University Chemistry Experience Summer School

Application for 5 and 6 July 2010

Please complete by word processor, if possible, otherwise in black ink.

First Name:

Name you prefer to be known as:

Family Name (Surname)

Date of Birth

Home Address

Post Code

Gender

Mobile Phone Number

Home Phone Number

Email Address

Note communication will be via email in the first instance.

Please note any medical condition that we should be aware of. (You will also be required to fill in a health form nearer the time.)

School Information

School Name

School Address

School Phone Number

School Type

State / Independent Boys / Girls / Mixed

Day School / BoardingRural / Semi Rural / non-Rural

Approximate school population

Name of Head of Chemistry

Why are you applying for this Summer School in particular?

Have you any special dietary requirements such as vegetarian? If so, please comment.

Qualifications

GCSEs or Equivalent -please add additional subjects
Subject / Grade / Subject / Grade
Chemistry / French
Physics
Biology
Dual Science
Mathematics
English Language
English Literature
AS or A levels or Equivalent -please add additional subjects
AS Subjects Gained / Grade / A level Subjects to be taken / Grade
Chemistry / Chemistry
Physics / Physics
Biology / Biology
Mathematics / Mathematics

Parent/Guardian Permission

If you are under 16 at the time of application you will need parent/guardian permission.

I give my permission for my son/daughter to attend this summer school. I realise that my son/daughter will be under their own cognizance after the evening lectures. [There will,however, be a member of the School of Chemistry at the Hall of Residence in case of emergency.]

Signed ______Parent/Guardian

Please print name ______

Payment

In order to reserve a place on the summer school, please send a non-refundable deposit of £45. Please make the cheque payable to ‘University of Bristol’, enclose with this application form and send to:

Mrs Sue Williams

School of Chemistry

University of Bristol

Cantock’s Close

Bristol BS8 1TS

Successful applicants will be notified by email.

Notes

  1. The full cost of the summer school is £145. We will require payment of the balance (ie £100) by Monday, 31 May 2010.
  2. The fee does not include transport to and from Bristol ChemLabS from your own home.
  3. You will need to walk to and from the hall of residence to the School of Chemistry. (The hall of residence is about 15 minutes’ walk from the University.) Please note that you should come to the School of Chemistry on Monday, 5 July (and not the hall of residence!). We will lock your luggage away during the day and transport it up to the hall later in the day.
  4. The accommodation at a hall of residence for Monday, 5 July, is included in the total cost. However, some of you travelling from further afield in the UK may require accommodation for the Sunday night. If this is the case, please could you let us know in advance. This will cost an additional £30.00 (including breakfast) per student. Please could you send us the payment for this accommodation at the same time you send us your final instalment for the summer school.
  5. A provisional programme of the summer school is attached.
  6. Contact for any additional information or if you have any queries.

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