King’s College London

Department of Chemistry

Summer School Application form

  1. Forename(s):
  2. Surname:
  3. Date of birth (DD-MM-YYYY):
  4. Please tell us your gender:

☐a) Male

☐b) Female

☐c) Trans

☐d) Other

If you selected other, please specify and include which pronouns you would like us to use:

  1. Please tell us your ethnicity:

☐White – English / Welsh / Scottish / Northern Irish / British

☐White – Irish

☐White – Gypsy or Irish Traveller

☐Any Other White Background (please specify):

☐Mixed / Multiple ethnic group – White and Black Caribbean

☐Mixed / Multiple ethnic group – White and Black African

☐Mixed / Multiple ethnic group – White and Asian

☐Any Other Mixed / multiple ethnic background (please specify):

☐Asian / Asian British – Indian

☐Asian / Asian British - Pakistani

☐Asian / Asian British - Bangladeshi

☐Asian / Asian British – Chinese

☐Any other Asian background (please specify):

☐Black / African / Caribbean / Black British – African

☐Black / African / Caribbean / Black British – Caribbean

☐Any other Black / African / Caribbean background (please specify):

☐Other ethnic group – Arab

☐Not known

☐Prefer not to say

☐Other (please specify):

  1. Do you consider yourself to be disabled or to have a learning difficulty? Please tick all that apply:

☐None

☐You have a social / communication impairment

☐You are blind or have a serious visual impairment

☐You are deaf or have a serious hearing impairment

☐You have a long-standing illness or health condition

☐You have a mental health condition

☐You have a specific learning difficulty

☐You have physical impairment or mobility issues

☐Prefer not to say

☐Other

  1. If you selected Other, please specify:
  2. If you selected any of the above, please provide us with any information that you feel would be relevant to support you in your visit to King’s:
  1. Email address (this is our primary means of contacting you so please ensure it is correct):
  1. Your primary contact phone number:
  1. First line of your address:
  1. Second line of your address (if applicable):
  1. Postcode for your home address. Please enter in capitals and include a space e.g. SE1 8WA:
  1. If applicable, please tell us in which London or Greater London borough you live:
  1. How did you hear about the Department of Chemistry Summer School?:

☐a) At a King’s event

☐b) One of your teachers

☐c) A previous attendee

☐d) Chemistry Department website

☐e) Other, please specify:

  1. Current school or college:
  1. What year group are currently in?
  1. If you are planning to study A-Levels (or equivalent), what subjects are you planning to study?
  1. Why does a career in science appeal to you? (Max 200 words)
  1. What have you already done to investigate the realities of a career in science? (Max. 200 words, you can write in bullet points)
  1. How will completing a work experience placement at the Department of Chemistry help you?(Max. 200 words, you can write in bullet points)
  1. What do you think you would bring to the program?(Max. 200 words, you can write in bullet points)
  1. I confirm that I intend to study at least one science subject at A Level ☐
  1. By signing below, I confirm that all the information contained in this application is true, accurate and correct: