International High School Summer Programme Application Form

The University of Nottingham Ningbo China International High School Summer Programme Application Form

1. PERSONAL DETAILS

First Name(s): Last Name:

Passport Number: Email address:

Title Gender Date of Birth Nationality

Day Month Year

Correspondence address:

Home address: (If different from correspondence address)

Home telephone number: Mobile number: (With international code) (With international code)

Name of Emergency Contact:

Relationship to applicant:

Email: Telephone No:

If you have any specific individual requirements which are due to a disability, dyslexia or long-term medical condition, please give details, or enter N/A if not applicable:

2. QUALIFICATIONS AND GENERAL EDUCATIONAL BACKGROUND

Level Institution Qualification Type Result or Predicted Result Date awarded or expected

2.1 English Proficiency: If English is not your first language, have you taken any test (e.g. IELTS or TOEFL)? Please give details including score/grades and date of test. If you have already received high school-level instruction given in English, please give details here.

*Please attach your scanned test certificate with your application.

2.2 Referee: Please give details of a person whom we may contact concerning your application.

Name of referee:

Address: Occupation:

Email:

Telephone No.:

Relationship to applicant:

3. SOURCE

Where did you learn about the University of Nottingham Summer School?

Internet High School Friend Advertisement University Agent Other (please specify)

4. PAYMENT DETAILS

Please pay full fees when you are offered a place at Summer School by T/T transfer to following university bank account:  Bank Name : Bank of China Ningbo Branch

 Bank Address : 139 Yao Hang Street Ningbo China

 Swift Code : BKCHCNBJ92A

 Bank Account Number: 376658330575

 Bank Account Name : University of Nottingham Ningbo China

If you wish to make online payment, please request a payment code via: international- [email protected]

I declare that the information supplied in this form is true to the best of my knowledge and belief.

Signature: … ………………… Date: … ……………… Please return this form together with A copy of your passport and your English certificate to international-summer- [email protected].