SUMMER SCHOOL
Music - Application Form
Music Summer School July 2016
Are you passionate about music? Would you like to develop your skills in practice and theory? Would
you like to explore music at a higher level?
We’re offering 30 young people from London the chance to participate in a Music summer school at
Goldsmiths, involving teaching from professional musicians and academics, as well as the opportunity
to work alongside Goldsmiths undergraduate music students. This is an opportunity for you to work
within a music department with a world leading reputation.
The summer school will provide a week of creative music making, developing your skills as a
performer, songwriter or composer. Intensive group practical sessions will be supported by daily
sessions in music theory, aural and sight-reading, as well as sessions introducing creative digital music,
gamelan, film and TV music, and a taste of university-style lectures.
Please visit http://www.gold.ac.uk/music/ for more information about Music at Goldsmiths.
To take part you must:

Be aged between 16-25 years old

Have a passion for music, some experience as either a performer or composer, and a basic
understanding of music theory

Submit your application form by Monday 18th April

Commit to the full 5 days of study at Goldsmiths
The dates of the course are:

Monday 4th July – Friday 8th July 2015

From 9.30am – 4.45pm every day (these times are subject to change)

Venue: Goldsmiths, University of London
Lewisham Way, New Cross, London SE14 6NW (Closest stations are New Cross/New Cross
Gate)
If you have any problems filling in this form or have any further questions please contact
outreach@gold.ac.uk / 020 7717 2596.
APPLICANT INFORMATION
Last Name
First Name
D.O.B
Gender
Male ☐
Female ☐
Address 1
Address 2
City
Postcode
Telephone
Email
Do you have a registered disability, recognised impairment, long-term health condition, or a specific learning
difficulty?
Yes ☐
No ☐
If yes, please specify:
Which of the following ethnic groups do you belong to?
White ☐
Black African ☐
Black Caribbean ☐
Black (other) ☐
Asian (Bangladeshi) ☐
Asian (Chinese) ☐
Asian (Indian) ☐
Asian (Pakistani) ☐
Asian (other) ☐
Mixed (White/Asian) ☐
Mixed (White/Black African
☐
Mixed (White/Black
Caribbean) ☐
Mixed (other) ☐
I do not wish to supply this information ☐
Other (please specify)
Have you ever received a 16–19 bursary?
Yes ☐
No ☐
Have you received free school meals (FSM)?
Yes ☐
No ☐
Have you been a young carer (e.g. for a family member)?
Yes ☐
No ☐
Have you ever been in the care of a local authority?
Yes ☐
No ☐
How did you hear about the Goldsmiths Summer Schools?
School / Teacher ☐
Goldsmiths website ☐
At a Goldsmiths event (e.g. Open
Day / stand at an HE Fair) ☐
From a friend ☐
Other (please specify):
EDUCATION
What subject(s) are you interested in studying at
University?
What school do you currently attend?
What subjects are you currently studying?
Subject
Qualification (e.g. A-Level / BTEC)
What subjects did you study at GCSE (or equivalent) and what grades did you achieve?
Subject
Grade
Subject
Grade
ABOUT YOU
Please state briefly why you would like to attend the Music summer school at Goldsmiths, including what areas of music currently
interest you (200 words)
Please tell us what Music knowledge/experience you have, including what instrument(s) you play and your approximate level:
How would you rate your music reading skills? Good [
] Average [
] Basic [
] Very basic [
]
For the musicianship and music theory sessions you will join one of two groups: Please indicate which group you feel would be
most suitable for you.
Group 1 (approximately Grades 1-3 theory) [
]
Group 2 (approximately Grades 3-5 theory) [
]
DATA PROTECTION
The Goldsmiths Summer School is designed to target learners from communities under-represented in higher education. Information about parent /
carer / guardian occupations and 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. In addition, this data may also be shared with the Higher Education Funding
Council for England (HEFCE) and/or the applicant’s school or college for monitoring purposes and to evaluate the effectiveness of this activity as
part of the University policy to widen participation amongst under-represented groups. Goldsmiths 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 administrative 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 Outreach Team, RHB124, Goldsmiths, University of London, London SE14 6NW.
I understand and agree to the terms and conditions above ☐
Student’s Name …………………………………………………………………………………..…………..………
Student’s Signature ………………………………………………………………Date……………………………..
PARENTS / GUARDIANS
Please ask a parent or guardian to fill in this section
Emergency Contact Information
Emergency contact Name
Emergency contact telephone number (daytime)
Emergency contact telephone number (evening/weekend)
What is your current household income (estimate) per year?
below £25,000 ☐
£25,001 – £30,000 ☐
£40,001 – £42,620 ☐
Above £42,620 ☐
£30,001 – £35,000 ☐
£35,001 – £40,000 ☐
Please could you provide details of your current employment:
Parent / Guardian 1
Name:
Relationship to applicant:
Occupation:
(please provide job title, or write ‘unemployed’ or ‘not a wage earner’ as appropriate)
Company:
Have you attended University in the UK?
Yes ☐
No ☐
Subject:
Qualification:
If yes, what University did you attend?
And what qualification did you achieve?
Parent / Guardian 2
Name:
Relationship to applicant:
Occupation:
(please provide job title, or write ‘unemployed’ or ‘not a wage earner’ as appropriate)
Company:
Have you attended University in the UK?
Yes ☐
No ☐
Subject:
Qualification:
If yes, what University did you attend?
And what qualification did you achieve?
We may wish to contact you to invite you to Goldsmiths Summer
Schools events, or update you with information about the summer
school.
If you wish to receive this information, please provide your email address
here.
This information will not be used for any other purpose.
During the Goldsmiths Summer Schools, photographs and/or
video/digital footage of your child participating in activities may be taken.
We would hope, in this way, to give your child a reminder of their course
experience. We may also wish to use this material, with no names
attached, to encourage other young people to take part in similar
courses (for example, by using it in future printed and web-based
publicity or in university prospectuses).
☐
If you consent to your child’s image being used in this way, please tick
this box:
Terms and Conditions
I agree to my son / daughter participating in the Goldsmiths Summer Schools I understand that some activities may take place outside of Goldsmiths
and I consent for my son/daughter to be taken on trips/activities, under appropriate supervision. I understand that any data on this form and on any
subsequent forms (e.g. evaluation forms) will be held by Goldsmiths in accordance with the Data Protection Act (1998) and will be used as outlined.
Goldsmiths 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 to the hand-over point at the beginning of the summer school, and again from the hand-over point at the end of the
programme.
Goldsmiths reserves the right to withdraw any student from the Goldsmiths Summer Schools who does not abide by this agreement.
I agree that I will not hold Goldsmiths responsible for any accident or injury caused by the negligent actions of my son/daughter.
Goldsmiths reserves the right to update and amend any terms and conditions at any point and you will be notified if these changes occur.
I have read and understand all terms and conditions (including on Data Protection) and consent to my child being part of the Goldsmiths Summer
Schools ☐
Name
Date
Once you have completed this form, please save it in the format: “YOUR_NAME_GSS_MUSIC” and send it as an
attachment to outreach@gold.ac.uk
Alternatively please post it to:
Summer Schools, Student Recruitment and Outreach, RHB124, Goldsmiths, University of London, New Cross,
London, SE14 6NW
DEADLINE: Monday 18th April