<p>PERSONAL & CONTACT DETAILS Family Name Title (Mr, Ms, Miss, Etc.) First Name(s) Gender (M/F/Other) Preferred Name Date of Birth (DD/MM/YY) Current Address Permanent Home Address (if different)</p><p>Tel Tel Email Email</p><p>SHORT TERM STUDY PROGRAMME OPTIONS Principal Study (Instrument / Voice type) UNDERGRADUATE POSTGRADUATE Please select ONE of the following options: Composition Composition Electronic Music Historical Performance Jazz Jazz Keyboard Keyboard Strings Keyboard (Piano Accompaniment) Vocal Strings Wind, Brass & Percussion Vocal Wind, Brass & Percussion ELECTIVE OPTION(S): (Elective options are subject to change and will be confirmed at the beginning of the course) Notes: Undergraduate applicants: Please select two options. Postgraduate applicants: Please select one option. Advanced Principal Study Jazz Performance Aural Keyboard Musicianship Harmony Second Study</p><p>CURRENT OR PREVIOUS STUDY Notes:  Applicants to the undergraduate programme will normally have secured a deferred place for a Bachelor (undergraduate) degree at another institution, or be in the process of applying for one  Applicants to the postgraduate programme will normally have completed a Bachelor (undergraduate) degree </p><p>Principal Study Teacher (if applicable) Current or last institution (School or University) Most recent qualification (e.g. High School Diploma or Bachelor of Music) Dates of study Start date: (MM/YY) End/Expected end date: (MM/YY) </p><p>Are you planning a gap year before starting a degree? Yes No Are you currently studying on an undergraduate degree? Yes No If yes, in which year of study? Have you already completed an undergraduate degree? Yes No If ‘no’ to all questions above, please provide further details of your most recent relevant study / work experience</p><p>Page 1 of 5 ENGLISH LANGUAGE Notes: Students will be expected to be competent in English at a minimum of CEFR level B2 order to benefit from the programme</p><p>Is English your first language? No Yes (please go straight to next section) If no, please indicate your current English Language ability: Spoken English: Fluent Good Moderate Limited None Written English: Fluent Good Moderate Limited None Have you taken an English language test within the last two No Yes, Overall score: years? (e.g. IELTS or TOEFL) Test type: Test date: </p><p>VISA SUPPORT & FEE ASSESSMENT Notes: You may be asked to provide additional documentary evidence of your nationality / immigration status</p><p>Nationality Dual Nationality (optional) Main Country of Will you require a Yes No Residence Short Term Study visa?</p><p>STATEMENT IN SUPPORT OF APPLICATION Please give a brief statement outlining why you would like to join the Short Term Study Programme at the Guildhall School.</p><p>AUDITION RECORDING / PORTFOLIO DECLARATION I confirm that I have included an audition recording / portfolio with this application that meets the Short Term Programme requirements. I am submitting my audition recording / portfolio by:</p><p>Online video recording (e.g. Vimeo or YouTube) Portfolio (in PDF format by email)</p><p>Web link: DVD (by post)</p><p>List of pieces performed on your recording (music performers) and/or scores indicated in your portfolio (for composers):</p><p>Additional notes on audition recording / portfolio (if applicable):</p><p>PAYMENT DECLARATION The application fee of £64.00 has been paid:</p><p>By credit/debit card or PayPal - online payment: By cheque, enclosed with posted application https://resources.gsmd.ac.uk/gsmdapp/paypalsc18.html Please make cheques payable to: Guildhall School of Music & Drama</p><p>DISABILITY Notes: If you have any special requirements due to a disability or a long term medical condition we would like to know about this so we can try to offer facilities which meet your needs for studying at the school. Please note that this information will not affect the academic decision made regarding your audition recording. Please see the Disability Support webpages for more information about support available at the Guildhall School. If you prefer to discuss this in confidence you can contact the Student Affairs Department on +44 (0)20 7382 7219.</p><p>Page 2 of 5 Do you have a disability or long-term Yes – Please provide further details below No Prefer not to say medical condition? </p><p>If Yes, which of the following best describes this: You have a social/communication impairment such as Asperger's syndrome or other autistic spectrum disorder (B) You are deaf or have a serious hearing impairment (D) You are blind or have a serious visual impairment uncorrected by glasses (C) You have a long standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease, or epilepsy (E) You have a specific learning difficulty such as dyslexia, dyspraxia or AD(H)D (G) You have a mental health condition, such as depression, schizophrenia or anxiety disorder (F) You have physical impairment or mobility issues, such as difficulty using your arms or using a wheelchair or crutches (H) You have two or more impairments and/or disabling medical conditions (J) You have a disability, impairment or medical condition that is not listed above (I) Please provide any further information about your disability or long term medical condition and any special arrangements you would need for studying at the School.</p><p>EQUALITY DATA Which of the following best describes your ethnicity? (Please select one) White British White Irish White Other Gypsy/Traveller Black or Black British - Black or Black British – African Other Black Background Caribbean Asian or Asian British - Asian or Asian British - Asian or Asian British – Other Asian Background Indian Pakistani Bangladeshi Mixed - White & Black Mixed - White & Black African Mixed - White & Asian Other Mixed Background Caribbean Chinese Arab Prefer not to say Other (please write): </p><p>CRIMINAL CONVICTIONS Notes: To help the Guildhall School reduce the risk of harm or injury to their students all students must let us know if they have any relevant unspent criminal convictions. Please refer to the Applications and Criminal Convictions section of our website for further information about spent convictions and our Safeguarding policy:</p><p>Do you have a relevant unspent criminal conviction? Yes No</p><p>DATA PROTECTION STATEMENT The Guildhall School of Music & Drama is a department of the City of London Corporation. The management of data is informed by the City of London's Data Protection Policy which is available through the Chamberlain's Department, Guildhall, London.</p><p>TERMS AND CONDITIONS & PRIVACY POLICY Please see: https://resources.gsmd.ac.uk/ego/privacy.pdf </p><p>APPLICANT DECLARATION By signing below, you - confirm that the statements made by you throughout this application form are correct. The Guildhall School reserves the right to withdraw or amend any offer made or terminate any subsequent registration should the statements be found to be incorrect. - agree to the Guildhall School of Music & Drama processing personal data contained in this form, or other data which the School may obtain from you or other people, for purposes connected with your studies, your health and safety or for any other legitimate reason. Photographs taken during productions and concerts may be used by the School for marketing purposes, including in its prospectus, events brochures, and website. To comply with statutory and government requirements, data may be disclosed to external agencies such as: Higher Education Funding Council for England, Higher Education Statistical Agency, Home Office, UKVI. Should you require a visa to study in the UK, the Guildhall School may need to discuss details of your application with the UKVI (UK Visas and Immigration). The UKVI is part of the Home Office. The Guildhall School is bound by the Data Protection Act, meaning that the School can only discuss details of the application with the applicant named on this application unless the applicant gives their permission.</p><p>Name</p><p>Page 3 of 5 Date </p><p>Page 4 of 5 SUBMISSION NOTES This application form should be sent (with audition recording material):  By email (preferred): [email protected] </p><p> By post: Corinna Sanett, Supplementary Programmes Manager Guildhall School of Music & Drama Silk Street, London, EC2Y 8DT, UK</p><p>Please make sure in all communication that you include your full name, programme applied for (Short Term Programme – Undergraduate / Postgraduate).</p><p>Page 5 of 5</p>