1. APPLICATION FORM
“Year 12 SOAS History Summer School”
Tuesday 26 th – Thursday 28 th June
SOAS, University of London: Russell Square Campus
STUDENT DETAILS (please print clearly)
Full Name ……………………………………………………………………………………………………………..
Date of Birth…………………………………………………… Male / Female
Home address (including postcode)………………………………………………………………………..
……………………………………………………………………………………………………………………………...
Mobile number…………………………………….Email………………………………………………………..
APPLICATION STATEMENT
Please write below (in no more than 150 words) why you would like to attend the SOAS
History Summer School:
Would you be the first in your family to go to university? Yes / No
EDUCATIONAL DETAILS
Current school / college………………………………………………………………………………………….
Subjects currently studied………………………………………………………………………………………
………………………………………………………………………………………………………………………………
School at which you took your GCSEs……………………………………………………………………..
Please turn over

2. Please list your GCSE results below:
Subject Grade
PARENT / GUARDIAN AGREEMENT
I agree to the student named above attending the summer school.
Signed……………………………………………………………………Date………………………………………..
Name (printed)………………………………………………………………………………………………………..
The UK Data Protection Act (1998) requires us to obtain your explicit consent to process and retain
your son/daughter's data. We will process this data in accordance with these principles. We will not
give your details to third parties except where necessary for the fulfilment of this application. We will
NOT USE the data provided in this form for marketing purposes.
Please tick this box to confirm that you give consent to the above use of this data. P
SCHOOL AGREEMENT
Signature of supporting teacher……………………………………………..Date…………………………
Teacher name (printed) …………………………………………………………………………………………..
Phone number………………………………………..email………………………………………………………
Please use the space below if you would like to add a brief supporting statement:
Please post to Sarah Tucker, ADD, SOAS, Thornhaugh St, Russell Square, London, WC1H 0XG
OR email to st47@soas.ac.uk OR fax to 020 7898 4549 Application deadline = Friday 30th March