Law school 2012 application form

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  • 1. Application FormLondon South Bank University, Faculty of Arts and Human Sciences Summer School:Law, Criminology, and Psychology in the Criminal Justice SystemTuesday 26 June to Thursday 28 June 2012Thank you for choosing to apply for the London South Bank University Law, Criminology andPsychology Summer School 2012. Please see the Summer School leaflet for details beforecompleting this formCompleted application forms need to be emailed to the following address by Monday 23 April2012:Partnership Liaison Officer (Arts and Human Sciences)Year12summerschool@lsbu.ac.ukAlternatively, you can post a completed application form to the following address by Friday 20April:Partnership Liaison Officer (AHS)Schools and Partnerships TeamLondon South Bank University103 Borough RoadLondonSE1 0AAPlease note, there are only 40 spaces available so try to get your application in quickly!Year 12 FAHS Summer School: Law, Criminology, and Psychology in the Criminal Justice System26-28 June 2012
  • 2. SECTION 1: INFORMATION ABOUT YOURSELF (Please complete in BLOCK CAPITALS)Forename(s)Surname / Family nameDate of Birth (dd/mm/yyyy)Home AddressHome PostcodeHome telephone numberMobile telephone numberEmail addressGender (please tick): Male FemaleWhich ethnic group do you belong to? (please tick one)This is for data monitoring purposes only Description Tick Description Tick Asian or Asian British - Bangladeshi Mixed - White & Black Caribbean Asian or Asian British - Indian Not known Asian or Asian British - Pakistani Other Asian background Black or Black British - African Other Black background Black or Black British - Caribbean Other Ethnic background Chinese Other Mixed background Irish Traveller White Mixed - White & Asian I do not wish to supply this information Mixed - White & Black AfricanDo you consider yourself to have a disability, special need or medical condition?Please tick Yes or No Yes  No If yes please specify:__________________________________________________________________________________________________________________________________________________________________Year 12 FAHS Summer School: Law, Criminology, and Psychology in the Criminal Justice System26-28 June 2012
  • 3. SECTION 1: INFORMATION ABOUT YOURSELF (Please complete in BLOCK CAPITALS)Information on your school/collegeSchool/College NameSchool/College AddressPlease detail the subjects and qualifications that you are currently studying for:Qualification: Subject:(e.g. A Levels, BTEC, Access course, etc)1)2)3)4)5)Data Protection The data collected here will be stored in accordance with the Data Protection Act and used for selection purposes and to administer and manage your application.DECLARATION TO BE SIGNED BY STUDENTI confirm that I wish to apply for a place on the Law, Criminology, and Psychology in the Criminal Justice System 2012at London South Bank University. I have checked that I will be able to attend every day of the 3 day Summer Schooland that I do not have exams or other commitments during Summer School week.Signature ………………………………………………………………Date………………………….…….Print name ………………………………………………………………………………………..…………...Year 12 FAHS Summer School: Law, Criminology, and Psychology in the Criminal Justice System26-28 June 2012
  • 4. SECTION 2: BACKGROUND INFORMATION:TO BE COMPLETED BY THE PARENT/GUARDIAN OR CARER IF THE APPLICANT IS UNDER 18Name of parent/guardian/carerYour relationship to the applicantDaytime contact numberAlternative contact number(s) (work/mobile)Email addressName of other adult in same household, ifapplicableRelationship to the applicantDaytime contact numberAlternative contact number(s) (work/mobile)Have either you or your partner achieved any higher education qualification in the UK? e.g. at a universityor through a further education college?(Higher education qualifications include: honours degree, degree. foundation degree, Higher National Diploma (HND),Higher National Certificate (HNC), Diploma of Education) YES NO If yes, please detail: …………………………………………………………………………………………………MarketingDuring the Spring/Summer Uni course, photographs and/or video/digital footage of your child participating in activitiesmay be taken. We may wish to use this material, with no names attached, to encourage other young people to take partin Spring/Summer Uni courses (for example, by using it in future printed and web-based Spring/Summer Uni publicity orin university prospectuses).If you consent to your child’s image being used in this way, please tick this box:Responsibility for your childThe higher education institution running your child’s Spring/Summer Uni course is responsible for the welfare of yourchild while he/she is attending the programme. As parent(s)/carer(s), you are responsible for the welfare of your childup until they arrive on campus at the beginning of the Spring/Summer Uni course, and again after they leave thecampus at the end of each day.Data ProtectionThis specific Spring/Summer Uni course scheme is designed to target learners from communities under-represented inhigher education. Information about parent/carer/guardian educational background might be used by the providers forthe purposes of prioritisation and selection or for monitoring the range of backgrounds from which applicants apply. Theapplicant’s school or college will not use your record in a way that would affect you individually. Under the DataProtection Act 1998, you have the right to a copy of the data held about you by us, for a small fee. If you have anyconcerns about the use of data for these purposes or would like a copy of the data you have supplied directly to us,please contact the Schools and Partnerships Team, London South Bank UniversityI consent to the use of my information for the purpose described: YESDECLARATION TO BE SIGNED BY PARENT/CARERYear 12 FAHS Summer School: Law, Criminology, and Psychology in the Criminal Justice System26-28 June 2012
  • 5. I have read the information above and understand that I will be responsible for my child up to the hand-over point atthe beginning of the programme and again from the hand-over point at the completion of the programmeI give my permission for my child to attend the year Law, Criminology, and Psychology in the Criminal Justice SystemSummer School.Signed………………………………………………………………………Date………………………………………………………Print name: ……………………………………………………..………………………………………….…………………………. Thank you. Please return this form to your child’s school/collegeSECTION 3: TO BE COMPLETED BY TEACHER/LECTURERI confirm that the information provided on this application form is correct and that the applicant has 5 GCSEs (A*- C)or equivalent. Additional Comments:Signed………………………………………………………………………Date………………………………………………………..Print name: ……………………………………………………..………………………………………….……………………………Position: …..…………………………….………………………………………………………………………………………………..Telephone: …………………………………..…………………………………………………………………………………………..Email address: …………………………………………………………………………………………………………………………..Year 12 FAHS Summer School: Law, Criminology, and Psychology in the Criminal Justice System26-28 June 2012