Independent Learning Archaeology Field School (ILAFS)
Application Form 2018
SECTION 1 – TO BE COMPLETED BY THE STUDENT – Please print clearly
ILAFSLocation / DatesSurname
Forename(s)
Home address
Post Code
Home telephone number
E-mail address
Date of birth
Gender / Male Female
Nationality
Current school/college year
Current school/college
Personal statement (please tell us a little about yourself, and then explain why you have decided to come on this course, what you hope to get out of it and how you hope it will be of benefit to you)
Have you considered what subject you might like to study at University?
No Yes If Yes, what subject(s)? ______
SECTION 2 – TO BE COMPLETED BY PARENT/CARER
We require that as a parent or carer you give your consent in order that your child is accepted to participate in the Independent Learning Archaeology Field School and provide certain information to allow course providers and funders to ensure that funds are being targeted appropriately. ALL INFORMATION WILL BE TREATED IN STRICTEST CONFIDENCE. We would therefore ask you to complete the attached parent/carer consent part of the form below.
Name of adult giving consent for applicant to attend course (in full)Relationship to applicant (mother/father, guardian or carer)
Reliable daytime contact phone number in case of emergency
Alternative contact phone numbers for you and/or second parent/carer (e.g. work/mobile)
Does your child have any of the following special needs? (Please tick Yes or No)
Note: This information will only be used to help us provide the most appropriate service for your child’s needs. ACA is keen to encourage young people who may have special educational needs and/or disabilities to consider higher education as an option for them.
- Any form of disability or special educational needs (e.g. specific learning difficulties such as dyslexia, dyspraxia and dyscalculia) Yes No
- Medical conditionsYes No
- AllergiesYes No
- Special requirements (e.g. diet)Yes No
If you have ticked ‘Yes’ to any of i-iv above, then please give details below, including any medication and/or special provisions required. Please also give any other details about your child which may be relevant for their learning experience (e.g. anxiety, in care, behavioural issues):
Complete the following information regarding your child’s doctor:
Name of Child’s Doctor: / Address of Child’s Doctor:Telephone Number of Child’s Doctor:
Date of Child’s Last Tetanus Injection:
In the event of an emergency I give my permission for a qualified member of staff to administer first aid and/or take my child to hospital : Yes No
Photo permission:
During the ILAFS, photographs and/or video/digital footage of your child participating in activities may be taken. We would hope, in this way, to give your child a reminder of their ILAFSexperience. We may also wish to use this material, with no names attached, to encourage other young people to take part in ILAFS (for example, by using it in future printed and web-based publicity or in university prospectuses).If you do NOT wish your child’s image to be used in this way, please tick the box:
Have either you or your partner achieved any higher education qualification (e.g. at a university or through a further education college)? (Higher education qualifications include: honours degree, degree, foundation degree, Higher National Diploma (HND), Higher National Certificate (HNC), Diploma of Higher Education). This must be for at least (or equivalent to) 1 year full time.
Please tick Yes or No Yes No
Do you consider yourself or your partner to be a managerial or professional worker?
Yes No
Mother/Carer
Father/Carer
Is this child eligible for free schools meals, or have they been in the last 3 years? (Please tick Yes or No)
Yes No
Is this child in care, or have they been in past? (Please tick Yes or No)
Yes No If yes, state if currently or previously and for what duration:………………...... ….………
Please tick the box that best describes the ethnic background of your child:
Arab
Asian or Asian British – Bangladeshi
Asian or Asian British– Indian
Asian or Asian British – Pakistani
Other Asian background
Black or Black British – Caribbean
Black or Black British – African
Other Black background
Chinese
Mixed - White and Black Caribbean
Mixed - White and Black African
Mixed - White and Asian
Other Mixed background
Other Ethnic background
White
White - British
White - Scottish
White - Irish
White - Other
Irish Traveller
Gypsy or Traveller
Not known
Information refused
Data Protection
Information about participants and parent/carer/guardian occupation and educational background might be used by the providers for the following purposes: 1. Tracking future outcomes of event participants including applications to the university and other Higher Education Institutions. 2.Producing statistics including event application and participation numbers, and participant outcomes. 3.Monitoring and research including (but not limited to) evaluation of the impact of this and other events (including events not organised by the University). As part of the wider Government policy to widen participation in higher education we will share this data with the following institutions/organisations/individuals 1. The University of Cambridge (including its Colleges, Departments and Faculties). 2. The Universities and Colleges Admissions Service (UCAS) 3. The Higher Education Statistics Agency (HESA) 4. The Department for Education 5. The Higher Education Access Tracker (HEAT) 6. Any third parties managing HEAT’s database 7. HEAT service subscribers and approved researchers. TheHE provider of the event your child will attend will not use your record in a way that would affect you individually. Under the Data Protection Act 1998, you have the right to a copy of the data held about you by us, for a small fee. If you have any concerns about the use of data for these purposes or would like a copy of the data you have supplied directly to us, please contact: The Administrator, Access Cambridge Archaeology, Department of Archaeology and Anthropology, University of Cambridge, Pembroke Street, Cambridge, CB2 3QG; Tel: 01223 761519; email:
I consent to the use of my information for the purpose described Yes No
DECLARATION TO BE SIGNED BY PARENT/CARER
I give my permission for my childto attend the field school
Signature of parent/guardian or carer: ______
Print name: ______Date signed: ______
SECTION 3 – TO BE COMPLETED BY MEMBER OF STAFF
If filling out multiple forms for many different applicants, give full information on each child and sign, but you only need fill out your full information on one form.
Staff name – (in full)Staff e-mail address
Position in school
Does the pupil have special needs, a specific learning difficulty or any other needs we should know about?
Please also mention if you would like this child placed with/away from anybody or other requirements.
Does the school receive Pupil premium for this pupil? / Yes No
All information relevant to the needs of this child has been given in this form and is true.
(tick box and sign) /
Signed: ______
Thank you. Please return this form to the following address:
Administrator, Access Cambridge Archaeology,
Division of Biological Anthropology
Department of Archaeology and Anthropology
University of Cambridge
Pembroke Street
Cambridge
CB2 3QG
Tel: 01223 761519Email: