Application Form for UDLL Student Focus Group

Application Form for UDLL Student Focus Group

Please complete the application form below outlining your motivation and interest to particpate and contribute to the Student Focus Group. All applications must bereturned to with [UDLL Student Focus Group Application] in the subject line before the 8th February 2015.

Contact Details & Basic Information

Country
First Name
Family Name
Mobile Number
Email Address
Disability[1]
Accessibility Requirements[2]

Educational Information

Higher Education Institution Name
Title of Study Programme
Undergraduate / Postgraduate[3]
Current Year of Study[4]

Motivational Question:

Answer the following question in text format (maximum of 300 words) or submit a selfie video (maximum of 3 minutes) which can contain pictures, texts, voices etc...

If you are submitting a video as part of your application, please upload your video to YouTube and ensure that the link is accessible by making your video ‘Public’ or ‘Unlisted’.

If you could advise your younger self, when you were considering university, what advice would you now give?

[Please insert 300 words here or the URL of your video.]

Terms & Conditions

•Applicants must be a current student at a higher education institution and have a disability to participate in the UDLL Student Focus Group.

•Successful applicants must be available and willing to travel to Dublin, Ireland from March 18th and returning on March 20th 2015.

•Successful applicants will not have to pay a fee to attend the UDLL Student Focus Group. Accommodation and travel costs will be arranged and covered by the UDLL project and meals will be provided from Wednesday 18th March to 20th March.

•Successful applicants to the UDLL Student Focus Group give their permission to the UDLL Project and partners to use your name and photographic likeness in all forms of media for advertising, promotion, trade and any other lawful purposes.

•All applicants will be added to a mailing list which they will recieve email updates and news in relation to the UDLL project.

Please type your name below if you understand and agree the Terms & Conditions outlined above.

NAME:

Thank you for submitting your application to participate in the UDLL Student Focus Group from the 18th - 20th March 2015.

Notifications regarding the status of your application will be sent the week beginning 9th February 2015.

If you have any questions, please email .

[1]Disability to mean anything that is a condition which has an impact, physical, sensory, ongoing illness, learning difficulty or mental health difficulty. We are collecting this information to ensure that we have an appropiate ratio of students with varying disabilities as part of the focus group.

[2]For example – wheelchair access, sign language interpreter etc...

[3]Undergraduate – a Bachelor degree course, Postgraduate – Masters or PhD etc…

[4]Please insert Year 1, Year 2, Year 3, Year 4 or Year 5.