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Name

First Name(s)

Preferred Name

Last Name

Home address

Address line 1

Address line 2

Postcode

Date of Birth (dd/mm/yyyy)

Mobile Phone Number

Email address

Confirm Email address

What is your gender?

Female
Male
Other

Are you the first generation in your family who will be attending university? (If you decide to apply). Do not include brothers or sisters in your answer.

Please try your best to find out the answer to this question, as it helps us to allocate places on the programme.

No
Yes
Don't know

Are you currently in receipt of free school meals, or have you received them in the past?

Please try your best to find out the answer to this question, as we use it to help us allocate places on the programme.

No
Yes
Don't know

Are you currently living in foster care or a children's home?

No
Yes

Are you a young carer?

A younger carer is someone age 18 or under who helps look after a relative who has a condition, such as a disability, illness, mental health condition or a drug or alcohol problem.

No
Yes

Have you lived in foster care or a children's home in the past?

No
Yes

Are you currently estranged from your family?

Estranged means that you are not supported by/not in communication with your parents.

No
Yes

Do you have a disability?

We encourage applications from students with disabilities and require this information for equal opportunities purposes only. The Disability Discrimination Act 1995 defines a disability as 'a physical, sensory or mental impairment which has a substantial and long-term adverse effect on a person's ability to carry out normal day-to-day activities'. This definition includes a wide range of sensory impairments, mental illnesses and learning difficulties as well as medical conditions that are likely to last 12 months or longer, or are likely to recur.

Please note, a "long standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease, or epilepsy" can be classed as a disability.

No
Yes
Prefer not to say

If you do have a disability, please provide details below.

Please tell us about the job of your main/highest earning parent or carer.

Pick the category by reading the examples provided and choosing the one that looks like the best fit.

Jobs like: Doctor, Solicitor, Office Manager, Finance Director, Nurse, Teacher, Retail Manager, Accountant, Administrator, Bank Staff, Nursery Nurse
Jobs like: Shopkeeper, Taxi Driver, Builder, Window Cleaner, Electrician, Plumber, Chef, Mechanic, Train Driver
Jobs like: Shop Assistant, Care Worker, Receptionist, Call Centre Worker, Cleaner, Hairdresser, Factory Worker, Waitress, Bus Driver, Lorry Driver
Never worked/long term unemployed: involuntary (e.g. due to disability, difficulty finding work etc
Never worked/long term unemployed: voluntary (e.g. stay-at-home parent)
None of these fit

If you really don't think any of the above categories is a good fit, or you would like to tell us more information about your parent's occupation, please use the box below to provide further details. Please do not provide vague information such as 'self-employed' or 'businessman'

School/College Details

This programme is only open to students attending a school in a London or Essex Borough.

Name of school/college

Borough your school falls within

Teacher Reference

Teacher's Name

Teacher's job title

Teacher's email

Confirm teacher's email

Please tell us, in no more than 150 words, why you would like to attend this programme.

For example: Why are you applying? What are your ambitions for the future?

How did you find out about this programme?

From a teacher in person
From a teacher/other staff member by email
From a friend
On a screen at school/college
Queen Mary Website
Web search

Data Protection Privacy Notice for Widening Participation

This privacy notice explains how Queen Mary University of London (QMUL) collects and uses personal data of people who attend events run by our Widening Participation team. It is in addition to QMUL’s Data Protection Policy.

Why are you asking me for this? Collecting this information helps us to evaluate how good our activities are at helping young people to achieve their full potential at school and find out more about university.

What will you do with my data? We will store this information on a secure database until you are aged 30. In the short term, we will use it to help us assess if we are reaching young people from backgrounds that are currently underrepresented in universities. Once you leave school/college we will send your data to the Higher Education Statistics Agency (HESA). They will tell us if you went to university, if you finished your degree and if you found a job at the end of your studies. We won’t ever use your data to send you ‘spam’ emails.

Who will you share it with? Only to enable the research and evaluation described above, your data may also be shared with the Higher Education Funding Council for England (HEFCE), the Universities and Colleges Admissions Service (UCAS), the Department for Education (DfE) or HESA, and our partners including Higher Education Access Tracker service subscribers and the National Data Service. We won’t ever share your data with companies for marketing purposes.

Will my data be safe? Yes, very safe. There are strict laws to make sure that we protect your personal details; we comply with the Data Protection Act and as of May 2018 the General Data Protection Regulation.

Can I change my mind? Yes. You have the right to ask us to delete your data at any time, just email j.benson-egglenton@qmul.ac.uk to do this. You also have the right to ask us what data we hold about you.

I’m still not sure… Please ask us about anything that concerns you or that is unclear. If you are really not comfortable with sharing your data, that is completely fine. You can still participate in our activities.

I agree for my data to be used as described in the 'How we use your data' section
I do not agree for my data to be used (Your data will be held only as long as it is needed for administration of the Year 10 Creating a Language University Week then it will be destroyed.)

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