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2016-2018
Cohort B
Use this Application form for Healthcare, Sport and Maths pathwaysFor dates, see list at the bottom of the application form.
Full Name
Preferred name / known as
School/College Name
Please choose only one
Healthcare (Nursing, Paramedic Science & other pathways)
Mathematics
Sport
Home Address
This form is available to download from www.brookes.ac.uk/brookesengage Application deadline Wednesday 2nd November 2016.
Please send to: Charlie Field, UK Recruitment and Partnerships, Lloyd 101, Oxford Brookes University, OX3 0BL. OR scan and email a signed copy to [email protected]
For help completing this form please contact Charlie on 01865 484980 / [email protected]
Post Code
Date of Birth
Telephone number (home)
Your mobile number
Your email address
Gender Male Female
What are you currently studying? Please include subject and qualification level, for example English A Level or Health and Social Care Level 3 BTEC. Please include any GCSEs you are currently re-taking.
Please list GCSEs achieved (or equivalent) with grades
Name of school where you sat your GCSEs: 2
Why do you wish to take part in Brookes Engage? Please tell us a bit about yourself here. What are your interests, hobbies, aspirations etc. Please continue on a separate sheet if necessary.
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Do you consider yourself to have a disability? Under the Equality Act 2010, a person has a disability if they have a physical or mental impairment which has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities. This may include people with chronic heart disease, cancer, HIV, diabetes, multiple sclerosis, epilepsy, severe disfigurement, depression, schizophrenia, Down's Syndrome, and dyslexia, for example. Further information is available at: www.gov.uk/definition-of-disability-under-equality-act-2010. Do you consider yourself to have a disability within the definition of the Equality Act 2010? YesNoPrefer not to say
If yes, what is the nature of your disability?
Which ethnic group do you belong to? Please tickWhite- British Black or Black British- African
White- Irish Black or Black British- Caribbean
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Other White Background Other Black Background
Asian or Asian British- Indian Mixed- White and Asian
Asian or Asian British- Bangladeshi Mixed- White and Black Caribbean
Asian or Asian British- Pakistani Mixed- White and Black African
Chinese Gypsy or Traveller
Other Asian Background Other Mixed Background
Arab Other Ethnic Background
Prefer not to say
Are you currently living in local authority care?
Yes No
Have you ever lived in care?
YesNo
Are you currently a young carer, or do you have previous experience of caring?
YesNo
Are you currently entitled to free school meals?
YesNo
Have you been entitled to free school meals in the past?
YesNo
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On a scale of 1 -5 please rate how likely you think it is that you will go to university:
Definitely no 1 2 3 4 5 Definitely yes
Have you taken part in an activity at Oxford Brookes University before?
YesNoIf yes, what?
Please list any dietary requirements you have (i.e vegetarian, halal, vegan, lactose intolerant)
Do you have any medical needs, or is there other information we should be aware of (medication, food allergies, etc)?
Please provide the name and contact details of a teacher who you are happy for us to be in touch with about your Brookes Engage application.
Teacher Name
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Telephone number
Email address
YOUR SIGNATURES
Data Protection Oxford Brookes University will collect and process your student data which will be stored on a database in accordance with the Data Protection Act and used to administer participation in the project. For research and monitoring purposes only, this data may also be shared with the Higher Education Statistics Agency (HESA), the University and Colleges Admissions Service (UCAS), the Higher Education Institutions subscribing to the Higher Education Access Tracker (HEAT) project and the Study Higher Partnership to help evaluate the effectiveness of this activity as part of the government policy to widen participation in higher education and to develop future policy. The HEAT project and its partners will not use your record in a way that would affect you individually. Under the Data Protection Act 1998 you have the right to a copy of the data held about you by us, for a small fee. If you have any concerns about the use of data for these purposes or would like a copy of the data you have supplied directly to us, requests should be made in writing to UK Recruitment, Oxford Brookes University, OX3 0BP.
Please sign in agreement to the data protection statement.
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Photographs During the programme photographs may be taken which could be used for publicity purposes or to display internally as examples of the activities being carried out. These photographs may be used locally, regionally or nationally in a variety of ways; i.e. printed resources, display boards, newsletters and articles or websites. Please sign here to indicate that you are happy for photographs taken to be used for the promotion of Brookes Engage and Oxford Brookes University.
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Date
YOUR PARENT/GUARDIAN SIGNATURES
Please ask your parent or guardian to complete this section:
Parent / Guardian 1 first name Parent / Guardian 1 last name
Preferred prefix Mr / Mrs / Ms / Miss / Other, please note __________________
Parent / Guardian 2 first name Parent / Guardian 2 last name
Preferred prefix Mr / Mrs / Ms / Miss / Other, please note __________________
Parent / Guardian contact number 1.
Parent / Guardian contact number 2.
Email address
Did you or your partner study at university, or are you currently studying at university?
Yes
No
If yes, please provide details (course name, level of study, university)
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Occasional trips will take place outside of the University. Please provide contact details here of how you would like to be kept informed of additional trips. Please include email address or telephone number.
Continued…The first session for Brookes Engage will take place at the University Thursday 1st December. Parents/Guardians are invited to join the cohort at 5.30pm to hear about the programme. The short talk will be followed by a drinks reception. Please indicate here if you are able to attend and the number of tickets required.
I can / cannot attend
I require _____ tickets.
Please sign here to indicate that you give permission for your child to take part in Brookes Engage. Sessions will take place monthly at Oxford Brookes University from 4-7pm on Wednesdays (date sheet attached). By signing here, you also give permission for your child to attend the residential summer school at Oxford Brookes from Wednesday 5th – Friday 7th July, staying overnight on campus in halls of residence).
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Date
This form is available to download from www.brookes.ac.uk/brookesengageApplication deadline Wednesday 2nd November 2016
Please send to: Charlie Field, UK Recruitment and Partnerships, Lloyd 101, Oxford Brookes University, OX3 0BL. OR scan and email a signed copy to [email protected]
For help completing this form please contact Charlie on 01865 484980 / [email protected]
DatesCOHORT B
Healthcare, Sport and Mathematics
Year 12 Thursday 1st December Launch and Welcome B
2017
Wednesday 11th January 4-7pm B (Goal setting) Wednesday 8th February 4-7pm B (Subject session)Thursday 8th March 4-7pm B (Choosing a Course)Wednesday 26th April 4-7pm B (Subject session) Wednesday 17th May 4-7pm B (library and careers)
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Wednesday 14th June 4-7pm B (Subject session)Weds 12th – Friday 14th July Summer school B (overnight 12th & 13th)
Year 13
Wednesday 20th September 4-7pm B (Interviews)Wednesday 18th October 4-7pm B (Subject session)Wednesday 22nd November 4-7pm B (Networking)Wednesday 13th December 4-7pm B (Subject session)
2018
Wednesday 24th January 4-7pm B (Societies)Wednesday 21st February 4-7pm B (Subject session) Wednesday 21st March 4-7pm B
Exam Break
Thursday 19th July Final session and graduation
Please note that students are expected to attend all sessions. Brookes Engage is completely free of charge and the cost of travel will be reimbursed.
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