International Summer School 2012

Application Form
To apply, please complete this application form electronically and return it by email or print to complete and return it by post/fax. In either format the application form must be submitted with the following:

• • •

An academic referee who is a member of staff at your current or recent college or university Passport photo (one digital if emailed, or two printed if posted) Proof of current Grade Point Average (GPA/academic transcript) Proof of IELTS score or equivalent English skill, if applicable

Upon arrival, students must show their medical/travel insurance certificate and, if a national of a non-EEA country, a student visitor visa. The University can decline entrance to the programme without these.

Personal Details
First Name Known as Date of Birth Nationality Postal Address Line 1 Line 2 City Country Phone Number (including country code) Email Address How did you hear about the University of East Anglia’s International Summer School? Home Institution Study Abroad/HE Fair Other UEA Website Flyer Brochure Poster Postal/Zip Code Surname Gender Age at 1 July, 2012
[Minimum accepted age at 1 July is 18]

Educational Details
Current/most recent home institution Country of home institution Highest qualification achieved: Degree Major Current level and year of study (e.g. undergraduate 2nd year)

UEA International Summer School 2012 Application


Current Grade Point Average (GPA) Awarding Institution

Award Date

You will need to provide documentation to support this with your submitted Application. Is English your first language Yes No

If English is not your first language, please provide proof of English proficiency. Level required is a minimum IELTS (or equivalent) score of 6.5. Please contact us before submitting an application if you do not meet the minimum requirement specified. Qualification Name Grade Received Award Date You will need to provide documentation to support this with your submitted Application. Academic referee First Name Institution Postal Address Line 1 Line 2 City Email Address Please ensure that your referee is willing to be contacted by the University should we need to verify your GPA or any other eligibility criteria. Country Postal/Zip Code Phone Number (including country code) Surname Relationship to Referee

Module Selection
Students will complete ONE 20 credit module during the International Summer School.
Our webpages will provide up to date information on availability. It may be possible to change preferences, subject to availability, after submitting an application. Places will be allocated on a first come first served basis with a deposit paid to secure choice(s) made. We recommend specifying a second and third option to secure a place on the Summer School. Please clearly specify module title as displayed at:

First module choice Second module choice Third module choice

Module Supplement
Students selecting Spirituality and Identity in the UK OR Contemporary British Theatre will be required to pay a supplement of £495 to cover London accommodation and excursions. Please tick to secure London accommodation/academic trips: London Supplement (£495)
Details of the London accommodation, academic trips and social programme in London are on our webpages. The supplement will be due with the programme fee balance by 31 May. The University reserves the right to withdraw the London element of the programme for the specified modules and relating supplement paid would be reimbursed in full.

UEA International Summer School 2012 Application


Disabilities/Additional Requirements
The University welcomes students with disabilities and strongly encourages you to disclose any disability or medical condition which may impact upon your studies. This will not affect the academic decision about your application but will help us put any individual arrangements or facilities in place for the start of your study abroad programme with us.

Please tick all that apply:
No known disabilities Mental health difficulties Learning difficulties Other Unseen disabilities e.g. diabetes Wheel chair user/Accessibility difficulty Autistic spectrum disorder/Asperger’s Blind/partially sighted Deaf/hearing impairment

Please provide details of any additional support you may require:

Equal Opportunities
The University aims to create an environment for learning that is tolerant and respectful, providing equal opportunities for all. To assist with our monitoring please indicate your ethnic origin. This information will not be considered as part of the application process.

White Black/Black British Asian/Asian British Mixed Chinese

Irish African Indian

British Caribbean Pakistan Bangladeshi

Other White background Other Black background Other Asian background White and Black African Other mixed background

White and Black Caribbean White and Asian

Other ethnic group

Additional Social Programme
The basic fee includes at least one weekday and one weekend activity each week. We’ve developed an exciting additional social programme bundle to give you a GREAT discount for a fun filled 4 weeks’ social activities! For activity details and pricing structures please read the Pricing Guide on our Social Programme webpages. A £100 deposit is required to secure the additional social programme advance price and this will be deducted from the balance due.

Please tick one option: Package A (£180) Package W1 (£385) Deposit Due £100

No Additional Social Package (at time of booking) Package B (£775) Package W2 (£385) Package L (£140) Package W3 (£385)

Total Amount for Social Package (inclusive of deposit)

Full payment will be due with the programme fee balance by 31 May. The University reserves the right to amend the dates of individual trips and in the event of a trip not running, an equivalent activity will be provided.

Full Board Catering
We’ve secured a GREAT deal with the University’s catering service so you can dine in our restaurant up to three times a day throughout your stay for less than £13.00 per day! This includes a full continental breakfast, a two course lunch and a 2 course dinner with selected drinks. For full options please visit our Fees webpages. The catering bundle can only be purchased in advance, requires a £100 deposit and must be paid for in full by the final fee deadline on 31 May.

Please tick one option: Package A (£335)

No Full Board Catering (at time of booking) Deposit Due £100

UEA International Summer School 2012 Application


Once an application is submitted we will respond with the outcome of the application, if successful a deposit of £200 is required to accept and confirm a place on the Summer School. The deposit is non refundable. This will be deducted from the final balance.
To secure the early registration fee, applications and a deposit of £200 must be received by the University of East Anglia before 1 February 2012. Students currently studying at one of our Partner universities receive a 5% discount from the standard registration fee. Please check our webpages on the Fees page for full terms and conditions and Partner details.

Please tick appropriate fee amount (fee includes en-suite accommodation and full tuition costs) Early Registration (before 1.2.12) £2,095 Standard Registration

Partner Early Registration


Partner Standard Registration £2194.45

Paying Your Fees
Fees can be paid through Uni-Pay, a secure online payment service and our preferred mode for international students. For full details with other payment options for the deposit and full and final balance please visit our webpages. Subject to being accepted onto the Summer School methods of payment will be advised. By signing below you agree to pay the full balance by the due date.

Total Balance Amount (Including Social/London/Catering supplements)

Declaration of Criminal Conviction
The University aims to create a safe learning and living environment for students and staff, and applicants must provide details of any relevant criminal conviction. Any information disclosed will be handled securely and confidentially.

Do you have an unspent criminal conviction?



If you have ticked yes, please disclose details of the offence and conviction separately.

By submitting an application form you are agreeing to pay any deposits by 30 April and the full fees by the balance due date 31 May 2012. Once a deposit is received by the University of East Anglia it is non-refundable, even if you decide not to attend the programme. The University of East Anglia reserves the right to cancel or amend the International Summer School programme for reasons of viability or due to any other unforeseen circumstances. Our full terms and conditions can be found on our webpages on the Fees page.

I Agree


Today’s Date (date of submission of application)

Returning the Application
Please return this form along with all supporting documents by email as an attachment, inserting your name as the document title, or as a hard copy by post. International Summer School Office Arts 0.73 University of East Anglia (UEA) Norwich Research Park Norwich Norfolk NR4 7TJ UK Tel: +44 (0) 1603 591514 Fax: +44(0) 1603 591998


We aim to process applications within 2 weeks of receipt and will respond to all applicants to advise outcome, with deadline for payment of deposit, total fee due and balance due date.

UEA International Summer School 2012 Application


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