Application form 2013

Please complete all parts of this application form in BLOCK CAPITALS You can also apply online at www.ice.cam.ac.uk/intsummer

PERSONAL DETAILS
Family/last name: Forename(s): Title (Mr/Miss/Mrs/Ms/Dr): Gender: Male r Female r Contact address: Country: Telephone number: Age: Nationality (as per your passport): Is English your first/native language? Yes r No r Please note: we require all applicants whose first language is not English to provide language proficiency test results from one of the following: IELTS/TOEFL/Cambridge CAE. An original or a certified copy of your results must be sent with this application. Please see the language requirements section on page 94 of the brochure.
(We will email booking/payment confirmation and Online Resource Centre information to this address)

Email address:

Date of birth (dd/mm/yy):

SPECIAL REQUIREMENTS
Equality Act 2010. Under the Equality Act 2010, a disability is any physical impairment which has substantial and long term adverse effect on an individuals ability to carry out normal day to day activities. We invite disclosure from anyone who feels they may have a disability or other condition which is likely to require additional support during their time on their selected courses.

We do not discriminate against people with disabilities or medical needs and make all reasonable efforts to accommodate their needs. Do you have any special physical or medical needs? No r Yes r If yes, we will contact you for further details. Dietary requirements:

ACADEMIC AND PROFESSIONAL DETAILS

Please give details of your educational background, including current study and degrees achieved: Studying for BA r BA r Studying for MA r MA r Employed r Studying for PhD r Retired r Academic r PhD r Other r No formal qualification r Profession: Other r

Please give details of your status: Student r

If you are currently a student, please state institution, course and year of study (eg University of Cambridge, Physics, 2nd Year): Institution: Course: Year:

If you are applying as part of a group from a college, university or other institution, please state which:

EMERGENCY CONTACT DETAILS

Please give details of someone we can contact in an emergency while you are in Cambridge: Name: Telephone number: Contact address:

Email address:

PROGRAMME AND COURSE CHOICE

INTERDISCIPLINARY SUMMER SCHOOLS Interdisciplinary Summer School Term I (8 July 2 August) Choose two or three special subject courses, each from a different group (A, B, C) First choice Second choice Third choice Interdisciplinary Summer School Term II (4 17 August) Choose two or three special subject courses, each from a different group (D, E, F) D E F First choice Second choice Third choice

A B C SPECIALIST SUMMER SCHOOLS Weeks 1 and 2 (7 20 July)

Science Term I (P courses) r Literature Term I (G and H courses) r Ancient Empires (A and E courses) r Week 1 First choice Second choice Third choice Week 2 P/Gb/Ab Hb/Eb First choice Second choice Third choice

P/Ga/Aa Ha/Ea Weeks 3 and 4 (21 July 3 August)

Science Term II (P courses) r Literature Term II (G and H courses) r History (L and M courses) r Week 1 First choice Second choice Third choice Week 2 P/Gd/Lb Hd/Mb First choice Second choice Third choice

P/Gc/La Hc/Ma Weeks 5 and 6 (4 17 August)

Shakespeare (R and S courses) r Medieval Studies (K and N courses) r Week 1 First choice Second choice Third choice Week 2 Rb/Kb Sb/Nb First choice Second choice Third choice

Ra/Ka Sa/Na Weeks 1, 2 and 3 (7 28 July) IELTS Preparation Course r Weeks 3, 4, 5 and 6 (21 July 17 August)

English for Academic Purposes r and I wish to take courses in Interdisciplinary Summer School Term II r, Shakespeare r or Medieval Studies r (one only). Please make your course selection in the relevant section above.

EVALUATION
Please mark with an asterisk (*) any courses above for which you would like to submit papers for Cambridge evaluation, eg Eb2*, Ha4* etc. Please note that there is an additional charge of 40 per evaluation.

HONOURS PROGRAMME
If you are applying for programmes that have a cumulative total of six weeks and would like to be considered for our very intensive Honours Programme, tick here to register your interest and receive further information r Please note: completed applications and relevant documentation for the Honours Programme must be received by 19 April 2013.

ACCOMMODATION
If you would like accommodation please write clearly 1 for first choice, 2 for second choice, 3 for third choice below. Places in Colleges are limited and are allocated in order of acceptance. You will be allocated to your second, or, if necessary, your third choice of accommodation if your first choice is full when you apply. Please note that specific room requests cannot be guaranteed. Please select only accommodation available to the Summer School(s) you have chosen (see below): INTERDISCIPLINARY SUMMER SCHOOL TERMS I AND II
Selwyn College Old Court standard Selwyn College Anns Court en suite Selwyn College Old Court en suite Newnham College standard Selwyn College Cripps Court standard Newnham College standard room only Newnham College en suite

ANCIENT EMPIRES SUMMER SCHOOL

St Catharines College standard St Catharines College en suite Gonville and Caius College standard Wolfson Court standard

SCIENCE, LITERATURE AND HISTORY SUMMER SCHOOLS

St Catharines College standard Gonville and Caius College standard St Catharines College en suite Wolfson Court standard Clare College standard Clare College en suite

SHAKESPEARE AND MEDIEVAL STUDIES SUMMER SCHOOLS

St Catharines College standard Gonville and Caius College standard St Catharines College en suite Clare College standard Clare College en suite Selwyn College Anns Court en suite

IELTS PREPARATION COURSE

St Catharines College standard St Catharines College en suite

ENGLISH FOR ACADEMIC PURPOSES

Selwyn College Anns Court en suite Newnham College standard Gonville and Caius College standard

Are you applying with another individual with whom you would like adjacent rooms? (Please note: we will do our best to meet your request, but it is not always possible to house people in adjacent rooms.) Name: If you are applying as a non-resident and finding your own accommodation, please tick here: r and give your expected address in Cambridge:

ACCOMMODATION BETWEEN DIFFERENT PROGRAMMES/TERMS

If you are attending consecutive programmes/terms, and would like accommodation between them please indicate below: Are additional night(s) required? Yes r No r Date(s) for extra night(s) of accommodation:

PUBLICITY/PREVIOUS ATTENDANCE
Have you attended a University of Cambridge Summer School before? Yes r No r How did you find out about the University of Cambridge International Summer Schools? Recommendation r My institution (please specify) Publication (which title?) Internet (which site?) Other (please specify)

COURSE MATERIALS AND DOCUMENTS

Course materials and registration documents will be available to download from the Online Resource Centre. Please tick here if you would prefer to receive paper copies sent by airmail r or by express mail r (For express mail 25 will be added to your invoice.)

SIGNATURE
I agree that the information on this application form is true at the time of writing and I have read this form, and the accompanying brochure and fully accept the terms and conditions, (including cancellation and refund policies) as stated in the brochure and on the Summer Schools website: www.ice.cam.ac.uk/intsummer/applying/terms-and-conditions. (Applicants without internet access should contact our office for a paper copy.) Applications cannot be accepted without a signature. Signed: Date:
Data will be processed for the purposes of education administration, including equal opportunities monitoring and to make returns to the Higher Education Statistics Agency. The data controller is the University of Cambridge, whose representative is the University Data Protection Officer, The Old Schools, Trinity Lane, Cambridge CB2 1TN. For further information go to: www.ice.cam.ac.uk/policies.

Please tick this box if you do NOT wish to receive future course brochure mailings r

PAYMENT
Non-refundable registration fee: Remainder of fee*: Additional night(s) of accommodation: Evaluation fees: 400 (four-week programmes) 200 (one-/two-/three-week programmes or terms) If you are applying for multiple programmes or terms you will need to pay the appropriate number of registration fees This is the full fee minus the registration fee see page 95 for details See page 93 for details of extra night(s) fees One course: 40; Two courses: 80; Three courses: 120; Four courses: 160

Amount

Grand total:

*If your first accommodation choice is full please tick to confirm we may charge you for the difference if your second or third choice is more expensive r

PAYMENT DETAILS
I wish to pay by:
(Please note: we do not accept American Express)

Credit or debit card (VISA/MasterCard/Eurocard/JCB) Sterling bankers draft drawn on a UK bank Cheque drawn on a UK bank Sterling travellers cheques Bank transfer

r r r r r

The University reserves the right to retrieve from applicants any bank charges or exchange costs that may be incurred. CHEQUES I enclose a cheque payable to the University of Cambridge for Personal cheques drawn on a non-UK bank cannot be accepted. . Please do not send cash.

CREDIT/DEBIT CARD If paying by credit or debit card please ensure that your credit limit is sufficient to cover the costs of the programme. You should check with your card issuer. I authorise the Institute of Continuing Education to debit my VISA/MasterCard/Eurocard/JCB (delete as appropriate) and I will pay the remaining balance by the balance of payment date for my programme(s) r I do not wish the University of Cambridge (ICE) to convert the amount into my home currency when taking the amount r
Card no. With the sum of Valid from Expiry date 3 digit security code: Issue no.

Name and address of cardholder if different from applicant:

Signature of cardholder: Signature of applicant if not cardholder: BANK TRANSFER Please send a copy of the bank transfer receipt with your application form. Any transfer of funds from outside the UK is subject to bank charges. Any bank charges outstanding on arrival will be charged when you register.

Barclays Bank, 9-11 St Andrews Street, Cambridge CB2 3AA Account Name: University of Cambridge Sort Code: 201719 Account Number: 10921084 SWIFT Code: BARC GB 22 IBAN Code: GB96 BARC 2017 1910 9210 84 Please quote reference: EA + student name (eg EA + John Smith) Please send your fully completed application form; three recent, colour passport-sized photos (3.5cm wide 4.5cm high /1.4 x 1.8), with your name and programmes you are applying for clearly printed on the back; proof of English language proficiency (if required); copy of bank transfer receipt (if required); relevant registration fee plus remaining fees if applying after balance of payment dates to: University of Cambridge International Programmes Institute of Continuing Education Madingley Hall, Madingley, Cambridge CB23 8AQ, UK Fax: +44 (0) 1223 760848