international summer schools 2013 application form 982

7/27/2019 International Summer Schools 2013 Application Form 982

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Application orm 2013Please complete all parts o this application orm in BLOCK CAPITALS

You can also apply online at www.ice.cam.ac.uk/intsummer

PERSONAL DETAILS

Family/last name:

Forename(s):

Title (Mr/Miss/Mrs/Ms/Dr): Gender: Maler Female r

Contact address:

Country:

Telephone number: Email address: (We will email booking/payment conrmation and Online Resource Centre inormation to this address)

Age: Date o birth (dd/mm/yy):

Nationality (as per your passport):

Is English your rst/native language? Yes r No r

Please note: we require allapplicants whose rst language is not English to provide language prociency test results rom one o theollowing: IELTS/TOEFL/Cambridge CAE. An original or a certied copy o your results must be sent with this application. Please see the

language requirements section on page 94 o the brochure.

SPECIAL REQUIREMENTS

Equality Act 2010. Under the Equality Act 2010, a disability is any physical impairment which has substantial and long term adverse eect on an individuals ability to carry out normal day to day

activities. We invite disclosure rom anyone who eels they may have a disability or other condition which is likely to require additional support during their time on their selected courses.

We do not discriminate against people with disabilities or medical needs and make all reasonable eorts to accommodate their needs.

Do you have any special physical or medical needs? No r Yes r I yes, we will contact you or urther details.

Dietary requirements:

ACADEMIC AND PROFESSIONAL DETAILS

Please give details o your educational background, including current study and degrees achieved:

Studying or BA r BA r Studying or MA r MA r Studying or PhD r PhDr No ormal qualication r Other r

Please give details o your status: Student r Employedr Retiredr Academic r Other r Proession:

I you are currently a student, please state institution, course and year o study (eg University o Cambridge, Physics, 2nd Year):

Institution: Course: Year:

I you are applying as part o a group rom a college, university or other institution, please state which:

EMERGENCY CONTACT DETAILS

Please give details o someone we can contact in an emergency while you are in Cambridge:

Name:

Telephone number:

Contact address:

Email address:


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PROGRAMME AND COURSE CHOICE

INTERDISCIPLINARY SUMMER SCHOOLS

Interdisciplinary Summer School Term I (8 July 2 August) Interdisciplinary Summer School Term II (4 17 August)Choose two or three special subject courses, Choose two or three special subject courses,each rom a dierent group (A, B, C) each rom a dierent group (D, E, F)

First choice Second choice Third choice First choice Second choice Third choice

A D

B E

C F

SPECIALIST SUMMER SCHOOLS

Weeks 1 and 2 (7 20 July)

Science Term I (P courses) r Literature Term I (G and H courses) r Ancient Empires (A and E courses) r

Week 1 First choice Second choice Third choice Week 2 First choice Second choice Third choice

P/Ga/Aa P/Gb/Ab

Ha/Ea Hb/Eb

Weeks 3 and 4 (21 July 3 August)

Science Term II (P courses) r Literature Term II (G and H courses) r History (L and M courses) r


P/Gc/La P/Gd/Lb

Hc/Ma Hd/Mb

Weeks 5 and 6 (4 17 August)

Shakespeare (R and S courses) r Medieval Studies (K and N courses) r


Ra/Ka Rb/Kb

Sa/Na Sb/Nb

Weeks 1, 2 and 3 (7 28 July)

IELTS Preparation Courser

Weeks 3, 4, 5 and 6 (21 July 17 August)

English or Academic Purposesrand I wish to take courses in Interdisciplinary Summer School Term II r, Shakespeare ror Medieval Studies r (one only). Please make your course selection in the relevant section above.

EVALUATION

Please mark with an asterisk (*) any courses above or which you would like to submit papers or Cambridge evaluation, eg Eb2*, Ha4*etc. Please note that there is an additional charge o 40 per evaluation.

HONOURS PROGRAMME

I you are applying or programmes that have a cumulative total o six weeks and would like to be considered or our very intensiveHonours Programme, tick here to register your interest and receive urther inormation r

Please note: completed applications and relevant documentation or the Honours Programme must be received by 19 April 2013.


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ACCOMMODATION

I you would like accommodation please write clearly 1 or rst choice, 2 or second choice, 3 or third choice below. Places inColleges are limited and are allocated in order o acceptance. You will be allocated to your second, or, i necessary, your third choice oaccommodation i your rst choice is ull when you apply. Please note that specic room requests cannot be guaranteed. Please selectonly accommodation available to the Summer School(s) you have chosen (see below):

INTERDISCIPLINARY SUMMER SCHOOL TERMS I AND II

Selwyn College Old Court standard Selwyn College Old Court en suite Selwyn College Cripps Court standard

Selwyn College Anns Court en suite Newnham College standard Newnham College en suite Newnham College standard room only

ANCIENT EMPIRES SUMMER SCHOOL

St Catharines College standard St Catharines College en suite Gonville and Caius College standard Wolson Court standard

SCIENCE, LITERATURE AND HISTORY SUMMER SCHOOLS

St Catharines College standard St Catharines College en suite Clare College standard Clare College en suite

Gonville and Caius College standard Wolson Court standard

SHAKESPEARE AND MEDIEVAL STUDIES SUMMER SCHOOLS

St Catharines College standard St Catharines College en suite Clare College standard Clare College en suite

Gonville and Caius College standard Selwyn College Anns Court en suite

IELTS PREPARATION COURSE

St Catharines College standard St Catharines College en suite

ENGLISH FOR ACADEMIC PURPOSES

Selwyn College Anns Court en suite Newnham College standard Gonville and Caius College standard

Are you applying with another individual with whom you would like adjacent rooms? (Please note: we will do our best to meet your

request, but it is not always possible to house people in adjacent rooms.) Name:

I you are applying as a non-resident and nding your own accommodation, please tick here: rand give your expected address

in Cambridge:

ACCOMMODATION BETWEEN DIFFERENT PROGRAMMES/TERMS

I you are attending consecutive programmes/terms, and would like accommodation between them please indicate below:Are additional night(s) required? Yes rNo rDate(s) or extra night(s) o accommodation:

PUBLICITY/PREVIOUS ATTENDANCE

Have you attended a University o Cambridge Summer School beore? Yes rNo r

How did you nd out about the University o Cambridge International Summer Schools?

RecommendationrMy institution (please speciy) Internet (which site?)

Publication (which title?) Other (please speciy)

COURSE MATERIALS AND DOCUMENTS

Course materials and registration documents will be available to download rom the Online Resource Centre. Please tick here i youwould preer to receive paper copies sent by airmail ror by express mail r(For express mail 25 will be added to your invoice.)

SIGNATURE

I agree that the inormation on this application orm is true at the time o writing and I have read this orm, and the accompanyingbrochure and ully accept the terms and conditions, (including cancellation and reund policies) as stated in the brochure and on theSummer Schools website: www.ice.cam.ac.uk/intsummer/applying/terms-and-conditions. (Applicants without internet access shouldcontact our ofce or a paper copy.) Applications cannot be accepted without a signature.

Signed: Date:

Data will be processed or the purposes o education administration, including equal opportunities monitoring and to make returns to the H igher Education Statistics Agency. The data controller is

the University o Cambridge, whose representative is the University Data Protection Ofcer, The Old Schools, Trinity Lane, Cambridge CB2 1TN. For urther inormation go to:

www.ice.cam.ac.uk/policies.

Please tick this box i you do NOT wish to receive uture course brochure mailings r


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Card no.

With the sum o Valid rom Expiry date Issue no.

3 digit security code:

PAYMENT

Non-reundable registration ee: 400 (our-week programmes)

200 (one-/two-/three-week programmes or terms)

If you are applying for multiple programmes or terms you

will need to pay the appropriate number of registration fees

Remainder o ee*: This is the ull ee minus the

registration ee see page 95 or details

Additional night(s) o accommodation: See page 93 or details o extra night(s) ees

Evaluation ees: One course: 40; Two courses: 80;

Three courses: 120; Four courses: 160

Grand total:

*I your rst accommodation choice is ull please t ick to conrm we may charge you or the diference i your second or third choice is more expensive r

PAYMENT DETAILS

I wish to pay by: Credit or debit card (VISA/MasterCard/Eurocard/JCB) r (Please note: we do not accept American Express)

Sterling bankers drat drawn on a UK bank r

Cheque drawn on a UK bank r

Sterling travellers cheques r

Bank transer r

The University reserves the right to retrieve rom applicants any bank charges or exchange costs that may be incurred.

CHEQUES I enclose a cheque payable to the University o Cambridge or . Please do not send cash.

Personal cheques drawn on a non-UK bank cannot be accepted.

CREDIT/DEBIT CARD I paying by credit or debit card please ensure that your credit limit is sufcient to cover the costs

o the programme. You should check with your card issuer.

I authorise the Institute o Continuing Education to debit my VISA/MasterCard/Eurocard/JCB (delete as appropriate)

and I will pay the remaining balance by the balance o payment date or my programme(s) r

I do not wish the University o Cambridge (ICE) to convert the amount into my home currency when taking the amount r

Name and address o cardholder i dierent rom applicant:

Signature o cardholder:

Signature o applicant i not cardholder:

BANK TRANSFER Please send a copy o the bank transer receipt with your application orm. Any transer o unds rom outside

the UK is subject to bank charges. Any bank charges outstanding on arrival will be charged when you register

Barclays Bank, 9-11 St Andrews Street, Cambridge CB2 3AA

Account Name: University o Cambridge Sort Code: 201719 Account Number: 10921084

SWIFT Code: BARC GB 22 IBAN Code: GB96 BARC 2017 1910 9210 84

Please quote reerence: EA + student name (eg EA + John Smith)

Please send your ully completed application orm; three recent, colour passport-sized photos (3.5cm wide 4.5cm high /1.4 x 1.8),

with your name and programmes you are applying or clearly printed on the back; proo o English language prociency (i required);

copy o bank transer receipt (i required); relevant registration ee plus remaining ees i applying ater balance o payment dates to:

University o Cambridge International Programmes

Institute o Continuing Education

Madingley Hall, Madingley,

Cambridge CB23 8AQ, UK

Fax: +44 (0) 1223 760848

Amount

international summer schools 2013 application form 982

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