Discovering Queen�s Year 14 Summer School � Application Form by mpU36R

VIEWS: 0 PAGES: 2

									                                   Year 13 Engineering Summer Project
          Queen’s University Belfast in collaboration with FG Wilson (Engineering) Limited
                                             Mon 20 - Fri 24 August 2012


Personal Details                                                                 PRIVATE & CONFIDENTIAL

Family Name:                                               First Name(s):


Address:                                                   Telephone Number:
                                                           Mobile:
Postcode:                                                  E Mail:

Date of Birth:                                             Male / Female (Delete as appropriate)
School Name & Address:



Have you attended any events at Queen’s University Belfast? Please give details.




Qualifications up to Year 12
 Title of Qualification     Year                             Title of Qualification    Year
     (e.g. GCSE /                     Subject      Grade         (e.g. GCSE /                    Subject         Grade
     BTEC,OCR)
                           Taken                                 BTEC,OCR)
                                                                                      Taken




Year 13 and proposed Year 14 course of study

                          Year 13                                                     Year 14
   Title of         Awarding                                   Title of         Awarding
                                         Subject                                                       Subject
 Qualification       Body                                    Qualification       Body




                                     Please return completed application forms to:
                    Discovering Queen’s, Rm 02.083 Lanyon North, Queen’s University Belfast, BT7 1NN
                                 Closing date for applications: Wednesday 18 July 2012
Do you consider yourself to have a disability?                                                             Yes   No
In accordance with the University’s equal opportunities policy, we would like to ensure that applicants,   □     □
regardless of disability, can participate fully in the Summer Project. If you indicate that you have a
disability we will contact you to discuss any necessary arrangements to enable your participation.



Personal Statement
Which careers are of most interest to you?

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Why are you applying for a place on the Engineering Summer Project?

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Please give details of your interests/activities and any positions of responsibility, including part-
time work, which you may have.

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

Data Protection


This information will be used by Queen’s University Belfast for the purposes of education and the associated
administration (i.e. selection criteria). This information will be retained for a period of three years after your
completion of the Summer Project. If you do not agree to Queen’s University Belfast processing this data as defined
above, please tick this box. 



Student Declaration
The information I have provided on this form is accurate.

Signature of Applicant:                                                  Name (Block Capitals):

Date:


Declaration by parent/guardian of applicants under the age of 18 at start of project:
I agree that __________________ may attend the Engineering Summer Project at Queen’s University Belfast.

Signature of Parent / Guardian:                                         Name (Block Capitals):

Address:                                                                Emergency Contact Number:

                                                                        Date:




                                     Please return completed application forms to:
                    Discovering Queen’s, Rm 02.083 Lanyon North, Queen’s University Belfast, BT7 1NN
                                 Closing date for applications: Wednesday 18 July 2012

								
To top