DMU Aspire Progression Programme application form

Personal details

Title

If other, please specify

Name

First name

Last name

Known as/preferred name

Initials

Date of birth (dd/mm/yyyy)

Country of birth

Gender

Ethnicity

Nationality

Address

Address Line 1

Address Line 2

City

County

Postcode

Country

Email

Mobile phone number

Home telephone number

School details

Name of school

Year of study

Please tell us what qualifications you are currently studying?

Personal statement

Use this section to tell us more about yourself and why you think you should be awarded a place, what you will gain from taking part and what you are looking forward to on the DMU Aspire Progression Programme.

Emergency contacts

Please specify two contacts

1. Name

First name

Last name

Relationship to student

Telephone number (work/mobile)

Telephone number (home)

2. Name

First name

Last name

Relationship to student

Telephone number (work/mobile)

Telephone number (home)

Medical requirements

Do you have any medical conditions we need to be aware of? If yes please specify. All responses will be treated in the strictest of confidence:

Are you allergic to any medication? If yes, please specify:

Do you have any allergies? If yes, please specify:

Do you have any special dietary/faith requirements? If yes, please specify:

Do you have any criminal convictions?

Do you have any specific learning or access needs which the university should be aware of?

Image and media capture policy

In accordance with the De Montfort University policy on image/media capture, we must inform you that this event may be photographed, videoed and/or otherwise captured in image/written form. Images/verbal or written quotes may be used in the university prospectus, course brochures, other publicity material (such as internal and external newsletters and publications) and exhibitions of student work. Images may also be provided to the media for publication in local or national newspapers or educational magazines.

I give permissionI do not give permission

Expected behaviour

Participating in the DMU Aspire Progression Programme will be very different from your experiences at school. DMUaspire aims for all students to benefit from the course and to enjoy this new experience. In order for this to happen, you will be expected to show responsible behaviour while attending the DMUaspire event as well as respect for the rights of other students and other DMU students/staff.

Declarations

I understand, and accept, the expected behaviour information written above.

I understand

I also agree to adhere to any additional rules and regulations explained to me on the first day of the DMU Aspire Progression Programme

I agree

I understand that I will not be allowed to continue on the DMU Aspire Progression Programme in the event of serious misbehaviour on my part.

I understand

Privacy notice

De Montfort University (DMU) will use the personal data supplied on the website to respond to your application. Please note that if you do not tick this box, we are unable to proceed with your enquiry. DMU complies fully with the Data Protection Act 1998 and other relevant legislation and personal data is never sold or passed to third parties for commercial use, and only used in conjunction with fulfilling your booking. Additionally, from time to time the university would like to follow-up on your enquiry with further relevant information that we feel would be of interest to you. The university would also like to contact you as part of an ongoing evaluation of the programme. Any further communications will detail how you can opt out of receiving more.

Confirmation

I have read the DMU privacy notice

Please upload a photo of yourself, photo needs to include a headshot with your face and shoulders in the photo on a pale background. This photo will be used to create your student account should you be successful in gaining a place on DMU Aspire Progression Programme. Should your application be unsuccessful all photos will be destroyed.