1. Application Form
London South Bank University, Faculty of Arts and Human Sciences Summer School:
Law, Criminology, and Psychology in the Criminal Justice System
Tuesday 26 June to Thursday 28 June 2012
Thank you for choosing to apply for the London South Bank University Law, Criminology and
Psychology Summer School 2012. Please see the Summer School leaflet for details before
completing this form
Completed application forms need to be emailed to the following address by Monday 23 April
2012:
Partnership Liaison Officer (Arts and Human Sciences)
Year12summerschool@lsbu.ac.uk
Alternatively, you can post a completed application form to the following address by Friday 20
April:
Partnership Liaison Officer (AHS)
Schools and Partnerships Team
London South Bank University
103 Borough Road
London
SE1 0AA
Please note, there are only 40 spaces available so try to get your application in quickly!
Year 12 FAHS Summer School: Law, Criminology, and Psychology in the Criminal Justice System
26-28 June 2012

2. SECTION 1: INFORMATION ABOUT YOURSELF (Please complete in BLOCK CAPITALS)
Forename(s)
Surname / Family name
Date of Birth (dd/mm/yyyy)
Home Address
Home Postcode
Home telephone number
Mobile telephone number
Email address
Gender (please tick): Male Female
Which ethnic group do you belong to? (please tick one)
This is for data monitoring purposes only
Description Tick Description Tick
Asian or Asian British - Bangladeshi Mixed - White & Black Caribbean
Asian or Asian British - Indian Not known
Asian or Asian British - Pakistani Other Asian background
Black or Black British - African Other Black background
Black or Black British - Caribbean Other Ethnic background
Chinese Other Mixed background
Irish Traveller White
Mixed - White & Asian
I do not wish to supply this information
Mixed - White & Black African
Do you consider yourself to have a disability, special need or medical condition?
Please tick Yes or No Yes  No 
If yes please specify:
_________________________________________________________________________________
_________________________________________________________________________________
Year 12 FAHS Summer School: Law, Criminology, and Psychology in the Criminal Justice System
26-28 June 2012

3. SECTION 1: INFORMATION ABOUT YOURSELF (Please complete in BLOCK CAPITALS)
Information on your school/college
School/College Name
School/College Address
Please detail the subjects and qualifications that you are currently studying for:
Qualification: Subject:
(e.g. A Levels, BTEC, Access course, etc)
1)
2)
3)
4)
5)
Data Protection
The data collected here will be stored in accordance with the Data Protection Act and used for selection purposes and to
administer and manage your application.
DECLARATION TO BE SIGNED BY STUDENT
I confirm that I wish to apply for a place on the Law, Criminology, and Psychology in the Criminal Justice System 2012
at London South Bank University. I have checked that I will be able to attend every day of the 3 day Summer School
and that I do not have exams or other commitments during Summer School week.
Signature ………………………………………………………………Date………………………….…….
Print name ………………………………………………………………………………………..…………...
Year 12 FAHS Summer School: Law, Criminology, and Psychology in the Criminal Justice System
26-28 June 2012

4. SECTION 2: BACKGROUND INFORMATION:
TO BE COMPLETED BY THE PARENT/GUARDIAN OR CARER IF THE APPLICANT IS UNDER 18
Name of parent/guardian/carer
Your relationship to the applicant
Daytime contact number
Alternative contact number(s) (work/mobile)
Email address
Name of other adult in same household, if
applicable
Relationship to the applicant
Daytime contact number
Alternative contact number(s) (work/mobile)
Have either you or your partner achieved any higher education qualification in the UK? e.g. at a university
or through a further education college?
(Higher education qualifications include: honours degree, degree. foundation degree, Higher National Diploma (HND),
Higher National Certificate (HNC), Diploma of Education)
YES NO If yes, please detail: …………………………………………………………………………………………………
Marketing
During the Spring/Summer Uni course, photographs and/or video/digital footage of your child participating in activities
may be taken. We may wish to use this material, with no names attached, to encourage other young people to take part
in Spring/Summer Uni courses (for example, by using it in future printed and web-based Spring/Summer Uni publicity or
in university prospectuses).
If you consent to your child’s image being used in this way, please tick this box:
Responsibility for your child
The higher education institution running your child’s Spring/Summer Uni course is responsible for the welfare of your
child while he/she is attending the programme. As parent(s)/carer(s), you are responsible for the welfare of your child
up until they arrive on campus at the beginning of the Spring/Summer Uni course, and again after they leave the
campus at the end of each day.
Data Protection
This specific Spring/Summer Uni course scheme is designed to target learners from communities under-represented in
higher education. Information about parent/carer/guardian educational background might be used by the providers for
the purposes of prioritisation and selection or for monitoring the range of backgrounds from which applicants apply. The
applicant’s school or college 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,
please contact the Schools and Partnerships Team, London South Bank University
I consent to the use of my information for the purpose described: YES
DECLARATION TO BE SIGNED BY PARENT/CARER
Year 12 FAHS Summer School: Law, Criminology, and Psychology in the Criminal Justice System
26-28 June 2012

5. I have read the information above and understand that I will be responsible for my child up to the hand-over point at
the beginning of the programme and again from the hand-over point at the completion of the programme
I give my permission for my child to attend the year Law, Criminology, and Psychology in the Criminal Justice System
Summer School.
Signed………………………………………………………………………Date………………………………………………………
Print name: ……………………………………………………..………………………………………….………………………….
Thank you. Please return this form to your child’s school/college
SECTION 3: TO BE COMPLETED BY TEACHER/LECTURER
I confirm that the information provided on this application form is correct and that the applicant has 5 GCSEs (A*- C)
or equivalent.
Additional Comments:
Signed………………………………………………………………………Date………………………………………………………..
Print name: ……………………………………………………..………………………………………….……………………………
Position: …..…………………………….………………………………………………………………………………………………..
Telephone: …………………………………..…………………………………………………………………………………………..
Email address: …………………………………………………………………………………………………………………………..
Year 12 FAHS Summer School: Law, Criminology, and Psychology in the Criminal Justice System
26-28 June 2012