UNIQ+ SUMMER SCHOOL

Application for 2019 entry

Before you apply, visit the UNIQ+ website to check whether you’re eligible:
www.graduate.ox.ac.uk/uniqplushome
The deadline for applying to UNIQ+ is 12 noon on Monday 29 April 2019. Your application,
supporting documents and references should all be submitted by this deadline.

HOW TO USE THIS FORM

You need to complete all sections of this form as honestly, accurately and comprehensively as you can.

This information, along with your supporting documents and references, allows us to assess your application. If
you’re shortlisted for or offered a place on UNIQ+, we may request further evidence to support your
application.

To apply, you’ll need to send us:

 This application form, as a Microsoft Word document (.doc/.docx)

 Your CV, as a PDF document
 Your university transcript, as a PDF document
 If relevant, your Student Finance or university letter confirming any undergraduate financial support,
as a PDF document.

This form and your supporting documents should be submitted online:

www.graduate.ox.ac.uk/uniqplusapply
We’ll also need two reference letters in support of your application, with at least one from a
tutor/advisor/professor at your university, sent by email to uniqplus@admin.ox.ac.uk.

DATA PROTECTION
Your personal data will be collected, stored and retained in accordance with the General Data Protection
Regulation and related UK data protection legislation. Please read the University's UNIQ+ Applicant Privacy
Notice before accepting the terms and conditions and submitting your application.

HELP WITH THIS FORM

If you’re unsure about any of the questions on this form, see ‘How to apply’ and our FAQs on the UNIQ+
website, or email us at uniqplus@admin.ox.ac.uk.
Section A: Your personal details

Please enter your name as it appears on your passport or other official document.

If you prefer to be called a name that is not on your official document(s), please write this in the Preferred Name box.

FIRST NAME Click or tap here to enter text. TITLE Choose an item.

MIDDLE NAMES Click or tap here to enter text. PREFERRED NAME Click or tap here to enter text.

SURNAME Click or tap here to enter text. GENDER Choose an item.

DATE OF BIRTH Click or tap to enter a date.

Section B: Your contact information

HOME ADDRESS CONTACT ADDRESS

If different from your home address
Click or tap here to enter text.
Click or tap here to enter text.
CITY Click or tap here to enter text.

CITY Click or tap here to enter text. COUNTY Click or tap here to enter text.

COUNTY Click or tap here to enter text. POSTCODE Click or tap here to enter text.

POSTCODE Click or tap here to enter text.

Which dates should we use this contact address for?
EMAIL Click or tap here to enter text.
From Click or tap to enter a date.
PHONE Click or tap here to enter text.
To Click or tap to enter a date.

Section C: Your nationality and residence

What is your nationality? Click or tap here to enter text.

Do you hold dual nationalities? ☐ Yes ☐ No

If yes, what other nationality/ies do you hold? Click or tap here to enter text.

I confirm that
 I am a UK resident;
 I am settled in the UK at the time of applying with no restrictions on the period for which I may stay in the UK;
 I have been resident in the UK since 1 July 2016, and this has not been for the main purpose of receiving full-time
education during any part of this period of time.
☐ Yes ☐ No

Since when have you been resident in the UK? Click or tap to enter a date.
Section D: Your proposed subject area

The 2019 UNIQ+ summer school will be centred around scientific research, for those wishing to learn more about research in
these subject areas:

 Pure and applied mathematics

 The interface between the mathematical and computational sciences and the biomedical sciences
 Laboratory-based research in the biological and medical sciences

Please briefly outline your preferred field of study/area of research and any research groups you are most interested in (max 100
words). (You can write more details in your personal statement)

Click or tap here to enter text.

Section E: Your education and, if relevant, employment

What was your school/college in your final calendar year of secondary education (normally this would be in your final year of
Sixth Form/FE college at age 18)?

SCHOOL NAME Click or tap here to enter text.

ADDRESS Click or tap here to enter text.

CITY Click or tap here to enter text.

COUNTY Click or tap here to enter text.

POSTCODE Click or tap here to enter text.

In which calendar year did you take your final exams in your final year of secondary education? Click or tap here to enter text.

Please provide in the table below information about your university education, including your current or completed
undergraduate degree (e.g. BA, BSc, etc.). Please note that UNIQ+ is not open to first year undergraduate students. Eligibility
criteria are available on our website.

University/Institution Current year Year of completion/ Qualification obtained or Main subject (e.g. Result/expected
attended of study expected completion studying for (e.g. BA, BSc) Chemistry, Physics) result classification

Click or tap here to Choose an Click or tap here to Click or tap here to Click or tap here to Choose an item.
enter text. item. enter text. enter text. enter text.

Click or tap here to Choose an Click or tap here to Click or tap here to Click or tap here to Choose an item.
enter text. item. enter text. enter text. enter text.
Section F: Your financial and socio-economic circumstances

If you have graduated, are you currently in employment? ☐ Yes ☐ No

If yes, what is your current annual gross income (before tax)? Choose an item.

Do/did you qualify for UK government support (maintenance loan and/or maintenance grant) when you last applied to your
regional funding agency (e.g. Student Finance England, Student Awards Agency for Scotland)?

☐ Yes ☐ No

If yes, please provide a scanned copy of the most recent letter from Student Finance confirming the undergraduate financial
support you receive/have received from the UK government.

Do/did you live at home (i.e. with your parents/guardians) in the current/last academic year of your undergraduate degree?

☐ Yes ☐ No

Please state your full UK home address in the last
calendar year of your secondary education before you
started your undergraduate degree (this would normally
be your final year of Sixth Form/FE college at age 18),
even if this is the same as your address in section A.
ADDRESS Click or tap here to enter text.
TOWN/CITY Click or tap here to enter text.
COUNTY Click or tap here to enter text.
POSTCODE Click or tap here to enter text.

Were you entitled to receive free school meals? Choose an item.

Have you ever been in the care of a Local Authority (public care)? ☐ Yes ☐ No

If you answered yes, please state for how long: Choose an item.

Please state the name of the Local Authority: Click or tap here to enter text.

Do/did you have day-to-day caring responsibilities? ☐ Yes ☐ No

If yes, please provide the following information:

Who is/was it for? (e.g. adult relative, dependent child/ren) Click or tap here to enter text.

How frequently do/did you have caring responsibilities? Click or tap here to enter text.
(e.g. daily, once a week, once a month, etc.)

For how long do/did you have caring responsibilities? Choose an item.

Do any of your parent(s)/guardian(s) have a full undergraduate degree or equivalent? Choose an item.
(e.g. BA, BSc, etc.)
Section G: Your personal statement

Please explain below why you would like to attend the UNIQ+ Summer School, and why you believe your background and/or
personal circumstances qualify you (up to 500 words).

Click or tap here to enter text.

Where did you hear about the UNIQ+ programme?

Click or tap here to enter text.

We may survey UNIQ+ applicants or participants to gather their feedback to help us improve future UNIQ+ summer schools.
Participation in the surveys will be optional. Do you give us your consent to contact you by email for this purpose?

☐ Yes ☐ No

Section H: Referees

Remember: it is your responsibility to contact referees and request that they send their reference to uniqplus@admin.ox.ac.uk by
the deadline of 12 noon on Monday 29 April 2019. Referees should use their institutional email addresses. You may wish to send
your referees this link www.graduate.ox.ac.uk/uniqplusreferee to explain what is required.

Referee 1 Referee 2

Title Choose an item. Title Choose an item.

First name Click or tap here to enter text. First name Click or tap here to enter text.

Surname Click or tap here to enter text. Surname Click or tap here to enter text.

Referee type Choose an item. Referee type Choose an item.

Organisation Click or tap here to enter text. Organisation Click or tap here to enter text.

Email Click or tap here to enter text. Email Click or tap here to enter text.

Relationship to you Click or tap here to enter text. Relationship to you Click or tap here to enter text.

Section I: Supporting materials

Please include these documents as PDFs when you send your application form and tick the boxes below to show which
documents you have provided with your application form.

☐ CV

☐ Transcript of your undergraduate degree (either your marks to date or your final transcript)

☐ If relevant, your most recent Student Finance letter (see Section F)

Section J: Declaration

Please read the UNIQ+ Applicant Privacy Notice and this Declaration carefully. By signing the Declaration, you confirm your
acceptance of the statements which form the Declaration. If you do not sign this form, we cannot process your application.

I understand that an application must be completed entirely by myself (the applicant) and no other person. I certify that I have
read the information provided on the website about the UNIQ+ Summer School and its aims as an access scheme for under-
represented groups in selective universities. I understand that admission to the UNIQ+ forms no part of the Oxford graduate
admissions process.

I confirm that the information I have provided on this application form is (to the best of my knowledge) true, accurate and
complete; and I agree to notify the University promptly (uniqplus@admin.ox.ac.uk) if any information contained on this
application form should change, in order to keep it true, accurate, current and complete.

I understand that the University reserves the right to audit the accuracy of the data which I have provided, by seeking proof of
the answers I have given. I understand that if I am unable to supply satisfactory proof when requested, to the timescale
requested, any offer of a place under this scheme may be withdrawn.

I understand that the admissions decisions to UNIQ+ Summer School taken by the University of Oxford rely on the statements
made on the application form and on the supporting documents supplied by my referees and me. I note that if the University
believes that any information or statement, including references, contained on my application form may not be true, accurate,
current and complete, it may take any necessary steps to verify that information or statement and retains the right to amend or
reject my application.

Digital signature (please type your full name) Click or tap here to enter text.
 Equal Opportunities – This section will be removed at receipt of the application
The information you supply on this page will be kept confidentially. We will not take this information into account when
assessing your application, which will be judged only on the basis of the eligibility and selection criteria presented on the
website. The information you provide will be treated in line with the General Data Protection Regulation (GDPR)
(www.admin.ox.ac.uk/councilsec/compliance/dataprotection).

If you wish to make us aware, for the consideration of your application, of any circumstances related to disability that
have/had an impact on your secondary and/or undergraduate education, please provide information in your personal
statement.

If you accept a place on the UNIQ+ Summer School, the information provided below under Section 2: Disability will be
shared on a strictly limited basis with key individuals in academic, administrative and support roles, including our Disability
Advisory Service, in order to work with you to put in place effective adjustments or study support.

Section 1: Ethnicity

With which ethnic group do you most identify? Choose an item.

Section 2: Disability

We are committed to ensuring that all selected applicants for UNIQ+ are able to attend, regardless of medical, accessibility or
disability requirements. Please tell us if you have a disability, including sensory or mobility impairments, long-term mental health
conditions, longstanding illnesses or health conditions, autism spectrum conditions, or specific learning difficulties such as
dyslexia, dyspraxia and ADHD.

☐ No known disability

☐ Prefer not to say

☐ A specific learning difficulty such as dyslexia, dyspraxia or ADHD

☐ A social/communication impairment such as an autism spectrum condition or disorder

☐ A longstanding illness or health condition such as epilepsy, diabetes, Crohn’s disease, or asthma

☐ A long-term mental health condition, such as bipolar disorder, obsessive compulsive disorder, an eating disorder, depression, an
_______anxiety disorder, or schizophrenia

☐ A physical impairment or mobility issues, such as difficulty using arms or hands, or requiring use of a wheelchair, crutches or other
_______mobility aid

☐ Deaf or a serious hearing impairment

☐ Blind or a serious visual impairment uncorrected by glasses

☐ A disability, impairment or medical condition that is not listed

If not listed, please specify: Click or tap here to enter text.

If you have selected a disability above – do you have any additional support needs?

☐ Require use of a wheelchair or other mobility aid
☐ Require step-free/level access or use of a lift
☐ Require personal care assistance for daily living activities
☐ Require living accommodation with specialist equipment (e.g.
_______hoists, height-adjustable beds, adapted bathroom facilities)
☐ Require use of a registered/licensed assistance animal for
_______visual, hearing, mobility or medical needs