<p>The University of Nottingham Ningbo China International High School Summer Programme Application Form </p><p>1. PERSONAL DETAILS</p><p>First Name(s): Last Name: </p><p>Passport Number: Email address: </p><p>Title Gender Date of Birth Nationality</p><p>Day Month Year</p><p>Correspondence address: </p><p>Home address: (If different from correspondence address)</p><p>Home telephone number: Mobile number: (With international code) (With international code)</p><p>Name of Emergency Contact: </p><p>Relationship to applicant: </p><p>Email: Telephone No: </p><p>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:</p><p>2. QUALIFICATIONS AND GENERAL EDUCATIONAL BACKGROUND</p><p>Level Institution Qualification Type Result or Predicted Result Date awarded or expected</p><p>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.</p><p>*Please attach your scanned test certificate with your application.</p><p>2.2 Referee: Please give details of a person whom we may contact concerning your application.</p><p>Name of referee: </p><p>Address: Occupation: </p><p>Email: </p><p>Telephone No.: </p><p>Relationship to applicant: </p><p>3. SOURCE</p><p>Where did you learn about the University of Nottingham Summer School?</p><p>Internet High School Friend Advertisement University Agent Other (please specify) </p><p>4. PAYMENT DETAILS</p><p>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 </p><p> Bank Address : 139 Yao Hang Street Ningbo China </p><p> Swift Code : BKCHCNBJ92A </p><p> Bank Account Number: 376658330575 </p><p> Bank Account Name : University of Nottingham Ningbo China</p><p>If you wish to make online payment, please request a payment code via: international- [email protected] </p><p>I declare that the information supplied in this form is true to the best of my knowledge and belief. </p><p>Signature: … ………………… Date: … ……………… Please return this form together with A copy of your passport and your English certificate to international-summer- [email protected]. </p>