Summer School Application Form 2017
ASPIRE: Introduction to
Higher Education
A Summer school for refugees and asylum seekers
A collaboration between Cardiff University and the Welsh Refugee Council,
with funding provided by the Pears Foundation.
3rd July 2017 – 10th August 2017
Personal Details
Name
Title
Male/Female / Other
Mr/Mrs/Ms/Miss
Email
Address
Post code
Telephone Number
Date of Birth
Next of Kin Details – who do we contact in an emergency, if something happens to you?
Name
Relationship to you
Special requirements
Do you have any disabilities? Please cross (x) the correct box *
Yes ☐ No ☐ prefer not to say ☐
If yes, please tell us about them here:
Do you have any dietary requirements?
Yes ☐ No ☐ prefer not to say ☐
If yes, please tell us about them here:
*computer hint: boxes can be crossed by clicking on them.
Contact Telephone
Number
Summer School Application Form 2017
Course Modules
1 Live Local, Learn Local Courses
We will be offering a choice of three six-week subject modules on the Summer School. Please rank the
modules in order of your preference, with 1 next to your first choice (the subject you most want to do), 2 next
to your second choice, and 3 your third choice. Please note that while we will try to fit everyone with their
first choice, this will depend on spaces being available in the class. Spaces are allocated on a first come,
first serve basis.
Description
Public Service
Interpreting for
Health
Every Monday from the 3rd July
– 7th August (inclusive)
2pm – 5pm
This course will give students an
overview of the understanding,
knowledge and skills required of a
public service interpreter in the
UK. It will include professional
conduct and development, health
specific terminology and basic
skills. If you want to work in health
or social care, or to be an
interpreter, this course is for you.
Introduction to
Business Management
Every Tuesday from the 4th July
– 8th August (inclusive)
2pm – 5pm
Do you want learn what skills you
need to work in business? This
course will look at everything you
need to know before you start.
From business plans, profit
margins and accounts through to
thinking of the future – learn how
to develop yourself as an
entrepreneur!
Peer Mentoring and
Coaching
Every Wednesday from the 5th
July- 9th August
2pm – 5pm
Coping with the stresses that
everyday life brings can be hard
on us, and on our family and
friends. The skills and selfawareness that you'll develop on
this course aim to help you deal
with what life throws at you in a
positive way, and to help you
learn how to support others in
your community. It can also serve
as an introduction to further
studies in health and social care,
psychology, or counselling.
Ranking
(1/2/3)
2
Module Dates
Page
Module Title
Summer School Application Form 2017
2. Intensive Academic English Language Course
We will be offering an intensive English language course for students wishing to progress
their academic English skills. The course will run every morning, Monday to Thursday
from the 3rd July – 10th August. The course is designed for those who intend to take an
IELTS/ Cambridge Academic English exam soon, and who currently have an UpperIntermediate/ Advanced level of English.
Please note: acceptance onto the course is subject to a short language assessment.
If you wish to apply for the Intensive Academic
English Language Course, please cross (X) here ☐
If you have crossed the box, the course co-ordinator will be in touch with you to arrange an
assessment.
Education History
EDUCATION HISTORY
Please tell us about your education and qualifications. Please
include qualifications gained overseas and those you are currently
undertaking.
Subject
Name of Institution
(school, college or
University) – please
include the name of the
country where study
took place
3
Date Gained / to
be gained
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Level /
Qualification
Summer School Application Form 2017
Please tell us a bit about your career background. What was your job before you came to the
United Kingdom? Have you worked in the United Kingdom? Please talk about both paid and
voluntary work that you have done.
Please use this space to tell us a bit about your current situation. What are you doing at the
moment? Are you studying/ volunteering/ working? If so, where?
Page
4
We want to know how attending the Sumer School will fit into your plans for the future. What do
you hope to do during your time in the UK? What is your dream career? Can you tell us what your
goals and ambitions are? How will attending the summer school help you achieve your goals and
ambitions?
Summer School Application Form 2017
What is your current residency status?
Asylum seeker ☐
Refugee ☐
Indefinite Leave to Remain ☐
British Citizen ☐
EU Citizen ☐
Discretionary Leave to Remain ☐
Humanitarian Protection ☐
Other (please specify):
Media Participation
We anticipate the Summer School to generate some media interest. If you are accepted onto the
scheme, would you be prepared to speak to the media, or to share your story in Cardiff University’s /
the Welsh Refugee Council’s promotional material?
Please note, content may be released on the internet, on television, and in print.
-
Yes, with my face and name shown ☐
Yes, but anonymously ☐
No ☐
Declaration:
I certify that the information given on this form is correct to the best of my knowledge. I consent to the
Welsh Refugee Council/ Cardiff University verifying any information given in this application.
Signature:
Date:
Thank you for your application! Once competed please submit to:
Page
or email a digital copy to [email protected]
Any questions, please call 02920489800/ 02920432977
5
Iona Hannagan Lewis
Welsh Refugee Council, 120-122 Broadway, Cardiff CF24 1NJ
Summer School Application Form 2017
Equality Monitoring
The Welsh Refugee Council wants to meet the aims and commitments set out in its equality policy. This includes
not discriminating under the Equality Act 2010, and building an accurate picture of who is accessing classes and
workshops.
The organisation needs your help and co-operation to enable it to do this, but filling in this form is voluntary.
The information you provide will stay confidential, and be stored securely and limited to only some staff in the
organisation. The organisation may share this information with the Welsh Government, but only to demonstrate
that we are meeting the aims and objectives of the Equality Act 2010 for funding purposes. Any data that you
share will be kept confidential and anonymous.
Gender Male ☐
Female ☐
Neutral ☐ Prefer not to say ☐
Are you the same gender as you were when you were born?
Yes ☐ No ☐ Prefer not to say ☐
Are you married or in a civil partnership? Yes ☐
No ☐ Prefer not to say ☐
Age
16-24 ☐
25-29 ☐
30-34 ☐
35-39 ☐
40-44 ☐ 45-49
☐
50-54 ☐
55-59 ☐
60-64 ☐
65+
☐ Prefer not to say ☐
What is your ethnicity?
Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you
belong. Please tick the appropriate box
White/ Caucasian
English ☐
Welsh ☐ Scottish ☐ Northern Irish ☐ Irish ☐
British ☐ Gypsy or Irish Traveller ☐ European ☐ Prefer not to say ☐
Any other white background, please write in:
Mixed/multiple ethnic groups
White and Black Caribbean
☐
White and Black African ☐ White and Asian ☐
Prefer not to say
☐ Any other mixed background, please write in:
Asian/Asian British
Indian ☐
Pakistani ☐ Bangladeshi ☐
Chinese ☐ Prefer not to say ☐
Any other Asian background, please write in:
Black/ African/ Caribbean/ Black British
African ☐
Caribbean ☐ Prefer not to say ☐
Any other Black/African/Caribbean background, please write in:
Other ethnic group
Arab
☐
Kurdish ☐
Persian ☐ Prefer not to say ☐
Any other ethnic group, please write in:
Do you consider yourself to have a learning disability or condition?
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Do you consider yourself to have a mental disability or health condition?
Yes ☐ No ☐ Prefer not to say ☐
What is the effect or impact of your disability or condition on your ability to give your best at work? Please write in
here:
6
Do you consider yourself to have a physical disability or health condition?
Yes ☐ No ☐ Prefer not to say ☐
What is the effect or impact of your disability or health condition on your ability to give your best at work? Please
write in here:
Summer School Application Form 2017
Yes ☐ No ☐ Prefer not to say ☐
What is the effect or impact of your disability or condition on your ability to give your best at work? Please write in
here:
The information in this form is for monitoring purposes only. If you believe you need a ‘reasonable adjustment’,
then please discuss this with the course co-ordinator, or the manager running the course venue.
What is your sexual orientation?
Heterosexual ☐
Gay woman/lesbian ☐
Prefer not to say ☐
If other, please write in:
Gay man ☐
Bisexual ☐
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7
What is your religion or belief?
No religion or belief
☐
Buddhist ☐
Christian ☐
Hindu ☐ Jewish
☐
Muslim ☐
Sikh ☐ Prefer not to say ☐ If other religion or belief, please write in:
What is your current working pattern?
Full-time ☐
Part-time ☐
Prefer not to say ☐ None ☐
Do you have caring responsibilities? If yes, please tick all that apply
None ☐
Primary carer of a child/children (under 18) ☐
Primary carer of disabled child/children ☐
Primary carer of disabled adult (18 and over)  Primary carer of older person
☐
Secondary carer (another person carries out the main caring role) ☐
Prefer not to say
☐