Surname: Postcode: I can attend each day of the Summer School and all 16 Saturday sessions. I have completed all information in sections A, B, C and D

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1 CHOICE Study with the world s leading Social Science institution Summer School: Monday 17 Friday 21 August Saturday Sessions: 19 September March 2016 Deadline Friday 20 March 2015 First Name: Surname: Date of birth: Postcode: Current School/College: School for year 11 (if different): Checklist: Please tick to ensure you have completed the form correctly Student: I can attend each day of the Summer School and all 16 Saturday sessions I have completed all information in sections A, B, C and D I have written a personal statement in Section C I have signed Section D Parent/Carer: I have completed Section E and signed to give my consent Teacher: I have given a reference in support of this application in Section F and signed to confirm the details provided are correct. Please note: If incorrect information is found to be submitted in order to favour the application this will result in withdrawal from the programme. 1

2 CHOICE Summer School: Monday 17 Friday 21 August Saturday Sessions: 19 September March 2016 Completing this form You need to complete Sections A, B, C and D in BLOCK CAPITALS. Then pass the application to your parent/carer who must complete Section E. Then hand to your teacher who needs to complete Section F. They will then return the application form to us on your behalf. Section A Personal information Please complete in BLOCK CAPITALS Surname (as it appears on passport): Date of birth: First Name (as it appears on passport): Known as: Gender: please tick Male Female Address: Postcode: Telephone (home): Mobile: address (required): Ethnic Background Please indicate which ethnic group you belong to by ticking one box. A White English/ Welsh/ Scottish/ rthern Irish/ British Irish Gypsy or Irish Traveler Any Other White background, please specify: B Mixed/multiple ethnic groups White and Black Caribbean White and Black African White and Asian Any other Mixed/multiple ethnic background, please specify: C Asian/Asian British Indian Pakistani Bangladeshi Chinese Any other Asian background, please specify: D Black/African/Caribbean/Black British African Caribbean Any other Black/African/ Caribbean background, please specify: E Other ethnic group Arab Any other ethnic group, please specify: F t Known/ t Provided 2

3 Do you consider yourself to have a disability? Please tick. If yes, please provide details Do you live under local authority care (eg, in foster care or a care home) Were you eligible for free school meals in Year 11? Section B Academic information Please list: GCSE grades Please list: AS Level grades Subject Grade Subject Predicted grade Have you ever participated in any other university outreach programmes? If yes, please give details: Section C LSE CHOICE streams First choice Second choice LSE CHOICE is offered in five streams in 2014: Economics Government and Politics History Mathematics Sociology Please list your first and second course choices. It is not always possible to receive your first choice subject. You must be intending to study the subject at A2. 3

4 Personal Statement Please tell us why you wish to take part in LSE CHOICE, and why you have selected your chosen subject. Please use all the space provided, if necessary continue on a seperate sheet. Please cover the following in your personal statement: your reasons for choosing the subject what you think you will gain from the summer school and Saturday master classes what you hope to do with this subject in the future. 4

5 Section D Future plans What do you plan to do after you have completed your A Levels? please tick one box University Go into work Training for a specific career Other please specify: Have you thought about going to university when you leave school/college?, I want to go I m not really sure, university s not for me Do you know which subject area you would like to study at University? (you can list up to two subjects) 1 2 Do you know what university you might like to attend? (By signing below you consent to information regarding the content and status of your application being shared with your school. You also consent to us contacting you about the summer school by text message) Pupil signature Date Section E Consent This section MUST be completed by a parent or carer. Parent/carer 1 Parent/carer 2 Name: Relationship to applicant: Occupation: address: Are you registered as unemployed or seeking work? Name: Relationship to applicant: Occupation: address: Is this person registered as unemployed or seeking work? Have you attended university? Has this person attended university? If yes Name of university: Course: Qualification received: If yes Name of university: Course: Qualification received: DECLARATION TO BE SIGNED BY A PARENT/CARER I have completed the form with the information to the best of my knowledge. The UK Data Protection Act (1998) requires us to obtain your explicit consent to process and retain your son s/ daughter s data as supplied on this application form. We will process this data in accordance with these principles. The data will be used and securely retained by LSE in order to process this application and to evaluate the project. We will NOT USE the data provided for marketing purposes or give the data to any third parties if permission has not been granted. Please tick this box to confirm that you give consent to the above use of data. Please contact if you have any concerns. I am the applicant s legal guardian PUBLICITY DISCLAIMER This event may be recorded and photographed solely for record and future publicity purposes by LSE and its agents, Please understand that by submitting this application any applicant, (or parent/guardian of an applicant) is agreeing for their image to appear in LSE printed publicity and promotional material and on the LSE website. If you have any objections to your son s/daughter s image being used for the above purpose please contact us at I give permission for my son/daughter apply to and participate in the LSE CHOICE Summer School and 16 Saturday sessions. Signature of parent/carer: Date: 5

6 Section F School This section MUST be completed by your school. Name of school/college: School postcode: Borough: School statement Please write a short statement outlining why this pupil should be considered for a place on the LSE CHOICE programme. Please refer to the notes in the School and Link Teacher information sheet to complete this statement. Please ensure that the school s statement in support of this application is personal. Generic statements will be detrimental to the pupil s application. All decisions will take the School statement into account. Declaration of support (to be signed by a teacher) I have checked the details on this application form and can verify the predicted grades in Section B. Please note applications which do not meet the eligibility criteria, or are incomplete will be returned to the signatory without consideration. Name: Position: Teacher signature: Date: Named school contact for applications (if different from above): Telephone: *INFORMATION FOR TEACHERS* Once all sections have been completed, please return to: CHOICE Co-ordinator, Student Recruitment Office, Room TW3 700, The London School of Economics and Political Science, Houghton Street, London WC2A 2AE DEADLINE FOR RECEIPT OF APPLICATIONS is Friday 20 March

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