Application Form

Applications are now open for the 2022/23 Outreach programme!

We look at each application individually. Please let us know of any other circumstances you would like us to take into consideration. The Outreach Team retains the right to make a final decision on eligibility to the programme.

Our data protection statement can be found on the tab above.

If you have any questions about this form please email outreach@brighton.ac.uk

Outreach programme application form - 2022-23

Parent/carer contact details

Please check with your parent, carer or legal guardian for the correct details, and complete this part of the form carefully. We would like to write to them and tell them about the programme and events we run for parents/carers. We also need to be able to contact them in case of an emergency while you are at one of our events. Young people in the care of the local authority should give the details of their social or key worker.

Parent, Carer or Guardian's First/Given name *

Parent, Carer or Guardian's Surname/Family name *

Relationship to student *

Parent, Carer or Guardian's Email Address *

Enter Email

Confirm Parent, Carer or Guardian's Email Address *

Confirm Email

Parent, Carer or Guardian's Phone Number *

A number that we can use in case of an emergency while you are at one of our events.

Agreement

The information I have given is complete and accurate and I understand that my data will be used as set out in the data protection statement which can be found at https://blogs.brighton.ac.uk/wideningparticipation/data-protection/, including being notified of activities which are part of the university's widening participation offer. When returning online, typed signatures will be accepted.

Student Signature *

Please type your name

I am happy to be contacted for research purposes by the University of Brighton

Yes

By submitting this form you are agreeing to the terms and conditions of the outreach programme. Which includes communications from the University of Brighton. We will only send you communications that are targeted and appropriate. We will not share your email address with anyone outside of the university for marketing purposes. You can opt out of communications at any point. *

Yes

Confidential equal opportunities monitoring

Please tick the appropriate boxes

Gender *

Male

Female

Gender fluid

Prefer not to say

Ethnicity *

Thank you

We will contact you as soon as possible to let you know the outcome of your application.

WP Data Protection statement
University of Brighton Privacy Policy (if you have signed up for updates from the University)

This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Application Form

Student details

Student questionnaire

Subject interests

Parent/carer contact details

Agreement

Confidential equal opportunities monitoring

Thank you