Please Complete This Form in Blue Or Black Ink, Using BLOCK CAPITALS

Please complete this form in blue or black ink, using BLOCK CAPITALS.

Section 1:Student information(To be completed by the applicant)

Name:

Address:

Email address:

Mobile number:

Date of birth: Gender:Male Female

The following information will help us to provide the most appropriate service for your needs:

Do you consider yourself to have a disability?YesNo

If yes, what is the nature of your disability?

Do you have any specific dietary requirements?YesNo

If yes, please specify?

Section 1:Student information(continued)

We’d like to know why you would be suitable to attend this university preview day. Please answer the following questions. Feel free to use an additional sheet if necessary.

1. Pleasewrite downone challenge and one opportunity that we face in studying post-2000 literature

1. Which work of post-2000 literature have you read recently? What did you most enjoy about that text?

1. What are you hoping to get out of thisuniversity preview day?

Declaration:

I declare that the information within this form is correct and true.

Signature: Date:

Section 2:Parental consent (To be completed by the applicant’s parent or guardian)

Name of parent/guardian:

Relationship to applicant:

t/carer information and consent

Emergency contact number/s:

Important information:

Declaration:

I have checked the information within this form and to the bestof my knowledge it is correct and true.I understand that I will be responsible for my son/daughter’s travel to and from the University of Reading for the university preview day. I give permission for my child to attend the event.

Signature: Date:

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Section 3:Teacher reference (To be completed by the applicant’s teacher)

Name of teacher:

Name of school/college:

School/college address:

School/college telephone:

Teacher’s email address:

Name of child protection officer:

Child protection officer telephone:

Section 3:Teacher reference (continued)

We’d like to know why your student would be suitable to attend this university preview day. Noting the eligibility criteria below, please give a short reference. Feel free to use an additional sheet if necessary.

Eligibility Criteria

Some experience of reading post-2000 literature; high level of enthusiasm for English Literature in general; predicted grades consistent with an application to study English Literature at University.

Declaration:

I have checked the information within this form and to the best of my knowledge it is correct and true. I confirm my support for this application

Signature: Date:

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Data protection

The information that has been provided in this form is confidential and will be treated in accordance with theData Protection Act (1998). Only organisations that require information for the funding, delivery evaluation and tracking of the Summer School, the student’s school/college, the Universities and Colleges Admissions Service, and the High Education Statistics Authority will be given access to the data. Data will be stored on a secure database for future tracking. We will not use the data provided in the form for marketing purposes. Please note: due to both the Data Protection Act (1998) and childprotection policies, only the parent/carer who has signed the form can be given access to the data provided.

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All done?Please return the completed form to the address below, by Friday 10 June 2015:

Ms Katy Green • • 0118 378 8124

School of Literature and Languages, University of Reading, Whiteknights, Reading, RG6 6AA