Application for a place on the year 11 MSC summer school (2-5 July 19) Journey to Medicine
Medical Careers Residential - South West Region, an MSC Summer School
This form is administered by Erin@naturallearning.org.uk
HEE NHS
Exeter university medical school
Use of data
The details you provide in this form will be used to make decisions about who gets a place on the summer school. We will keep the contact details for the duration of the residential and then delete them. We will ask a teacher at your school for a reference for you. We will use other details anonymously, such as postcode for research and analysis.
Please tick to confirm you are happy for us to use your data in this way. *
Required
Name of person completing the form *
Your answer
Young person information
First name *
Your answer
Last name *
Your answer
Name of school or college *
Your answer
Name of a teacher who can provide a reference for you. *
Your answer
Home address *
Your answer
Home postcode *
Your answer
Pupil mobile number
Your answer
Pupil home telephone number *
Your answer
Pupil Email *
Your answer
Gender *
So that we can accommodate you, please give details of any disability you may have. If none, please state: 'none'.
Your answer
Parent / career details
Parent/carer telephone number *
Your answer
Second telephone number for emergency contact *
Your answer
Parent/carer email *
Your answer
We will select students for the summer school based on a range of eligibility criteria. Please do answer the following questions as fully as possible.
• Are you eligible for free school meals? *
Required
• Have you spent time in local authority care? *
Required
• Are you a young carer? *
Required
• Has either of your parents got a university degree from either the UK or abroad? *
Required
• Are you a refugee or asylum seeker? *
Required
• Are you estranged (living without family support)? *
Required
What do you want to achieve from attending the MSC Summer School? [150 word limit] *
Your answer
Declaration. The information provided is true and correct. I understand that in providing incorrect information any offer of a place of a summer school can be revoked. I am happy for this data to be shared with the teacher who will provide further information.
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