Application form for study as a one-year undergraduate
Please fill in and pass to the first referee named on p.4, enclosing the documents requested. Please ask the referee to
complete the questions on the back page and to send the completed form to the Admissions Tutor, Pembroke College,
Cambridge CB2 1RF by 31st January 2016 at the latest. Please note that we also require a second reference, to be sent to
us in a sealed envelope, either with the application or separately, to arrive by the same date. Photocopies of this form are
acceptable.
This is an application form for a place to study at Pembroke from October 2016 to June 2017. Please tick the box
to confirm that you are not applying for a similar studentship for this period at any other Cambridge College
I am not applying elsewhere in Cambridge (please tick)
please affix
photograph
Surname:
First name:
Date of Birth:
Sex:
Marital Status:
Place & Country of Birth:
Nationality:
E-mail address ..................................................................................................................................
Country of residence since October 2013 (other than merely for educational purposes)
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Home address:
Full University name and address:
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Is your address for correspondence
Home/University?
Funding arrangements:
Name of scholarship or other scheme supporting application (if this is not Junior Year Abroad, the Studienstiftung des
deutschen Volkes, or DAAD, please attach details of the history and nature of the scheme)
Level of support expected from it
Estimated date by which you will know if you will get this support
Subjects studied, and grades obtained, at university to date (please attach academic transcript)
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Subject studied
Grade
Final examination results from school (AP, Abitur etc): please give marks in individual subjects. Give SAT scores as
well if applicable. Please continue on a separate sheet if necessary.
Subject
Grade
Qualifications in the English language (if this is not your native language)
Dates of attendance at school and university (since age 13)
Name of Institution
From
To
Expected date of graduation from university
What credits, if any, do you need to obtain during your proposed study in Cambridge?
Are you willing to take papers in the Cambridge Tripos (course) examinations at the end of your period of study here?
Why do you wish to study at Cambridge?
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Please list other applications you are making for the year 2016-2017. Please indicate which of these (if not Cambridge) is
your first choice.
Which Cambridge’s Tripos subject [ONE ONLY] would you wish to study? Please specify from the list at
www.pem.cam.ac.uk/admiss/ug/courses/ . Give reasons.
Please indicate which papers (classes) within your chosen Cambridge “Tripos” subject you would be interested in taking,
if offered a place. If you are unsure about this, please contact Pembroke College Admissions Office for further details
before submitting your application. Full details of the papers (classes) offered within each subject can be found at
www.cam.ac.uk/admissions/undergraduate/courses
Please give information about the level and content of subjects and papers (classes) you have taken which are relevant to
your intended programme of study. If you are applying for a scientific subject, please list in detail on a separate sheet the
courses studied in your first two years at university; we cannot consider your application without this information.
Outline your plans for the remainder of your university degree, and for your career, specifically how studying your
preferred Tripos subject (and papers (classes)) at Cambridge will help with those plans
Signed ....................................................................................................................................................
Date .......................................................................................................................................................
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Names and addresses of two referees familiar with your university work. One, who should be a member of the staff in
the Faculty or Department in which you are enrolled, should complete the rest of the form; the other should write to us
directly in support of your application, to reach us by 31st January 2016.
Name .....................................................................................................................................................
Address ..................................................................................................................................................
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Name .....................................................................................................................................................
Address .................................................................................................................................................
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Please ask a suitable member of staff at your university to answer the following questions:
Do you support this application?
Please comment, in detail, on the candidate's academic achievement to date, commitment, capacity for independent
study, and suitability for the course of study proposed on this form. (Please use a separate sheet if necessary)
What qualifications, examination passes, or other credits, if any, do you require the candidate to bring home from the
period of study in Cambridge?
Signed..........................................................................................Position..................................................................................
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Date ........................................................................................................................................................
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