Application for Summer School 2016
Academic Session: 2016-17
Completed forms should be returned by Monday 27th June 2016 to:
Phillipa McNeill
University of Glasgow
Rutherford McCowan Building
Dumfries Campus
Bankend Road
Dumfries, DG1 4ZL
Phillipa.McNeill@glasgow.ac.uk
1. Personal details
Surname:
First name:
Title: Mr
Date of Birth:
Are you holding an offer for a programme at the University of Glasgow? If so, please enter the degree
title.
UCAS Personal ID Number (if you have one):
Email address:
Address:
Postcode:
Telephone number:
Country of permanent residence:
Nationality:
Have you previously studied at the University of Glasgow? If so please give details (matriculation
number, course, dates, any previous surnames).
Which degree course would you like to access through Summer School? (please tick)
MA (Hons) Health and Social Policy
BSc (Hons) Environmental Science and Sustainability
2. English Language
Is English your native language?
If you answered ‘No’ please list any formal English Language Qualifications you have or intend to gain
before commencing the Summer School (Qualification, date of award, result).
3. Qualifications
 You should include copies of transcripts of your qualifications with your application
 Please do not leave this section blank, even if a CV is enclosed
 If you are expecting exam results during 2015, you may insert predicted grades. These should be
prefixed by the letter ‘P’
Name of School/
University/College
Dates attended
Qualification
Subject
Grade
4. Employment
Please enter your employment history since you last attended school, college or university.
Dates
employed
Employers name and address
Post
Main responsibilities
5. Why would you like to apply for Summer School?
6. Do you have any other experience which you feel may support your application?
For example, skills gained through voluntary work, sports, hobbies, involvement with the community, or
other responsibilities and interests
Reference
Please complete this section as well as including a reference from your referee on the attached sheet in
a sealed envelope. If you are a school or college student, your referee should be one of your
teachers/lecturers or a guidance teacher.
Name:
Post held:
Address:
Postcode:
Telephone number:
Email address:
7. Declaration
I hereby apply for the Summer School 2015 at the University of Glasgow (Dumfries Campus) and I
confirm that the information given in this form is correct. I confirm that the documentation I have
supplied with my application is genuine, and I understand that the University will withdraw my
application if any aspect of my application is found to have been falsified.
I hereby confirm that I understand that the University of Glasgow will accept no liability for my tuition
fees or living expenses in the event of my admission.
Signature
Date
The University collects information about its students for various academic, administrative, health and
safety reasons. The information is processed in accordance with the 1998 Data Protection Act, and is
disclosed to third parties only with the individual’s consent or to meet a statutory obligation, an example
of which is the disclosure of information to the Higher Education Statistics Agency.
We may wish to contact you from time to time with information on new course developments and events
such as Open Day at the University. Please tick here if you DO NOT wish to receive this information. 
Completed forms should be returned by Monday 27th June 2016 to:
Phillipa McNeill
University of Glasgow
Rutherford McCowan Building
Dumfries Campus
Bankend Road
Dumfries, DG1 4ZL
Or emailed to:
Phillipa.McNeill@glasgow.ac.uk
Checklist:
 APPLICATION FORM
 REFEREE’S REPORT (IN SEALED ENVELOPE)
 MONITORING FORM
 COPIES OF YOUR QUALIFICATIONS (WE CAN MAKE COPIES IF YOU BRING THESE IN
PERSON WITH YOUR APPLICATION)
We may be able to accept late applications but please apply as soon as possible. Contact us first if you
wish to make a late application. Informal enquiries can be made by emailing
Phillip.McNeill@glasgow.ac.uk or Stuart.Hanscomb@glasgow.ac.uk
Referees Report: Summer School 2016 (Dumfries Campus)
Instructions to applicants
Please ask your referee to complete this form and enclose it in a sealed envelope, which has been
signed along the seal. You should then submit this along with your application form.
Please note that the University will not normally request references on your behalf and that your
application will not normally be processed until your reference has been received.
Instructions to referees
The reference should comment on the applicant’s suitability for the course at this time.
You should enclose this form in a sealed envelope, which has been signed along the seal, and return it
to the applicant.
The University of Glasgow does not routinely acknowledge receipt of references, however we would like
to thank you for providing this reference – it will be helpful in our decision on admission.
Applicant’s details and reference
Applicant’s full name:
Reference (please comment on the applicant’s skills, experience and suitability for this programme of
study).
Referee’s full name:
Post held:
Referee’s signature:
Date:
MONITORING FORM
The University collects information about its students for various academic, administrative, health and
safety reasons. The information is processed in accordance with the 1998 Data Protection Act, and is
disclosed to third parties only with the individual’s consent or to meet a statutory obligation, an example
of which is the disclosure of information to the Higher Education Statistics Agency. The information you
supply on this sheet will be filed separately and not revealed to those making the academic decision on
your application.
CRIMINAL CONVICTIONS
To help us reduce the risk of harm or injury to our students by the criminal behaviour of other students,
we must know about any relevant criminal convictions that an applicant may have.
Relevant criminal convictions are only those for offences against the person, whether of a violent or
sexual nature, and convictions for offences involving unlawfully supplying controlled drugs or
substances where the conviction concerns commercial drug dealing or trafficking. Convictions that are
spent (as defined by the Rehabilitation of Offenders Act 1974) are not considered to be relevant and
you should not reveal them.
Applicants who enter X in the box will not be automatically excluded from the application process.
However, we may want to consider the application further or ask for more information before making a
decision.
If you are convicted of a relevant criminal offence after you have applied, you must tell us during the
application cycle. Do not send details of the offence; simply tell us you have a relevant criminal
conviction. We may then ask you for more details.
CRIMINAL CONVICTIONS: If you have a relevant criminal conviction, enter X in the box.
See above for a definition of relevant criminal convictions
ETHNIC ORIGIN MONITORING
Please enter in the box the code from the list below which best describes your ethnic origin. Only
applicants whose permanent residence is in the UK are asked to answer this question. The University
has a statutory obligation to collect this information, which is required for statistical purposes only. This
information will not have any bearing on the outcome of your application.
11
12
13
19
21
22
29
31
32
33
34
39
41
42
43
49
80
90
98
White British
White Irish
White Scottish
Other White Background
Black Caribbean
Black African
Black Other
Indian
Pakistani
Bangladeshi
Chinese
Other Asian
White and Black
White and Black African
White and Black Asian
Other Mixed Background
Other
Not Known
Information Refused
Ethnic Origin Code
DISABILITY/SPECIAL NEEDS MONITORING
Please enter in the box the code from the list of statements below which is most appropriate to you,
and expand in a separate letter upon any needs you may have.
00
01
02
03
04
05
06
07
08
09
You do not have a disability nor are you aware of any associated
additional support requirements in study or accommodation
You have a specific learning difficulty (eg dyslexia)
You are blind / partially sighted
You are deaf / have a hearing impairment
You are a wheelchair user / have mobility difficulties
You have mental health difficulties
You have an unseen disability e.g. diabetes, epilepsy. Asthma, ME
You have multiple disabilities
You have a disability not listed above
You have autistic spectrum disorder / Asperger’s syndrome
Disability Code
Disabled Students’ Allowance: If you are a full-time or part-time student with a disability, you may
be eligible for Disabled Students’ Allowance (DSA), depending on the course for which you are
applying and your funding body. For further information contact:
Skill: National Bureau for Students with Disabilities
Chapter House
18-20 Crucifix Lane
London SE1 3JW
Voice / Text: 020 07450 0620
Fax: 020 7450 0650
Email:
Website:
skill@skill.org.uk
www.skill.org.uk
Please note that the University considers applications from candidates with disabilities on the same
academic grounds as apply to all candidates. Potential applicants are invited to visit the University
prior to formal application if they wish, and applicants who have a disability / special need which
may affect their studies are advised to contact Student Services as soon as possible, indicating the
course or courses in which they are interested and the nature of their disability. The Funding and
Enabling Support Advisers are available throughout the year to give personal advice and assistance
with practical and academic matters relating to disability. Further information is available from:
Tel: 01387 345825
Email:
Website:
studentservices-dumfries@uws.ac.uk
http://www.gla.ac.uk/schools/interdisciplinary/studentlife/studentservices/