Student ambassador application form 2012

For more information, please contact:

Raoul Morley
UCL Outreach Office
Room 24, 2nd floor, South Wing
E: raoul.morley@ucl.ac.uk
T: 020 7679 3929

Student Ambassador Application Form 2012

DEADLINE DATE

Student Ambassadors - 5pm Friday 12th October 2012

Personal Details

First Name *

Surname *

Preferred Name

UCL Email Address *

Alternative Email

Mobile Number *

Home Town *

Course Details

Degree Title *

Faculty *

Year of Study *

Year of Graduation *

Level of Study *

Previous Education

School/College Attended *

County/Borough

Are you the first in your family to go to university? * YesNo

About Your Application

You should fill each section in less than 100 words.

1. Why do you want to be a Student Ambassador? *

2. Why do you think that some young people don't go to university? *

3. What qualities or skills would you bring to the scheme? *

4. What experience have you had working with young people or the general public? *

5. What do you do in your spare time? * Tell us about any hobbies, extra-curricular activities or interests you have.

Are you part of any clubs or societies?

Equalities Monitoring

Gender *

Ethnicity *

Date of Birth *

Do you have a disability? * YesNo

Nationality *

Have you lived in local authority care? YesNo Have you ever lived in foster care or a care home?

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