Application No
University of Exeter
International Summer School 2012
Application Form
Please complete this form to apply for a place on the International Summer School taking place from21st July – 11thAugust 2012. Once complete either submit it to the selected contact at your university or email it to Lucy Thompson at . Alternatively you can post it to:
Lucy Thompson
International Office
8th Floor, LaverBuilding
North Park Road
Exeter
UK EX4 4QE
Please type or use BLOCK CAPITALS throughout.
Section 1: Pathway Choice
Which pathway do you wish to study:Section 2: Personal Details
Family name:Given name/s:
Title: Mr/Mrs/Miss/Ms (please circle) / Male / Female
(please circle)
Date of birth (DD/MM/YY):
Nationality (as it appears on your passport):
Correspondence address:
Email address: / Telephone number:
Details of the person to be contacted in the event of an accident or emergency:
Name:Address:
Telephone number (inc area code):
Email address:Relationship to you:
Section 3: Academic History
Please note we will require confirmation of your grades from your institution.
Title of degree programme:CurrentUniversity:
Year of study:
Module titles with grades achieved to date (please enclose a transcript):
Section 4: English Proficiency
Please indicate if your first language is English? Yes No (please tick relevant box)We will require all students, whose first language is not English, to have an appropriate English Language test result. If English is not your first language, please enclose a copy of your certificate with this application, or supply proof of an equivalent level of competence. If you are at a partner university to Exeter, you may be able to sit the English Language Proficiency Assessment. Please visit for more information on language requirements or contact the International Office at
Test taken and score: / Date of test:
Section 5: Health/ Dietary Requirements
Do you have any disability or medical condition that may necessitate special facilities, either in respect of accommodation, the academic course or the social programme? Please give details here:Do you have any special dietary requirements? Please give details here:
Section 6: Personal Statement
With particular reference to your chosen pathway, what benefits do you hope to gain from attendance at the International Summer School? Please indicate how attendance at the International Summer School will benefit your studies and/or career ambitions.Maximum: 150 words
Section 7: References
Please enclose one academic reference with your application. Please give details below of your referee’s name, address and relationship to you.Name:
Address:
Email:
Relationship to you:
Section 8: Immigration/visa
Students wishing to study on this programme will be able to apply for a Student VisitorVisa, either before entering the country (if you are a visa national) or at the point of entry (non-visa nationals), as the programme of study is less than six months. You are not allowed to work on a Student VisitorVisa or extend the visa from the UK.
For the Student VisitorVisa, theUniversity of Exeter will need to supply you with a letter of invitation in order for you to apply for your visa.
I am a visa national and will require an invitation letter from the University of Exeterto gain a Student Visitor Visa / Yes No (please tick relevant box)Data Protection
The University of Exeter requires the information you provide on this form for educational purposes. Your personal data will be processed in accordance with the University’s registration and current data protection legislation in the UK.
Disclaimer: Care has been taken in the preparation of this application form but no responsibility can be taken for any errors or omissions. The University reserves the right to cancel or alter the content of programmes due to unforeseen circumstances. If a programme is cancelled the applicant will be offered a full refund.
Declaration
The University is required under the provisions of the UK Rehabilitation of Offenders Act 1974 to require you to state whether or not you have any criminal convictions, excluding motoring offences. Please tick the appropriate box. If you tick ‘Yes’ you may be required to provide details of your conviction to the University.
Yes No
If I am accepted on to anInternational Summer School programme I agree to abide by the governing conditions. I confirm that the information I have given is true, complete and accurate, and no information requested or other material information has been omitted.
Signature ...... Date ......