Thanks for taking the time to register with Widening Participation at the Glasgow School of Art.
All pupils who wish to participate in our activities must complete this form before attending. The form should take no more than 10 minutes to complete.
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How did you find out about Widening Participation at GSA? *


 
First Name *

 
Surname *

 
Which year group are you in? *

As of August 2017

 
Date of Birth *

 
Scottish Candidate Number

Your Scottish Candidate Number (SCN) is displayed directly under your name on your SQA qualifications certificate. 

If you do not have it to hand, just leave this field blank and continue with the rest of the questions.

 
Home Address *

Please provide your full postal address, including flat number if applicable.
 
Postcode *

 
Mobile Number *

We may need to use this if you attend one of our events, so please make sure it is accurate.
 
Landline Number

If you do not have a landline telephone at home, please just leave this field blank and continue with the rest of the questions.
 
Emergency Contact Name *

This should be the name of someone who looks after you at home, and who you would want us to contact in the event of an emergency.
 
Emergency Contact Number *

Please make sure to give a mobile phone number so that we can contact this person quickly and easily in the event of an emergency.
 
Do you have any allergies? *

Please let us know if you have any allergies and make sure to tell us if you are allergic to any medication e.g. Penicillin
 
Please tell us about any medication you take which we should be aware of *

If you do not take any medication, just leave this field blank and continue with the rest of the questions.

If you are taking medication, please also provide your dosage. We would need to provide this information to a paramedic or doctor in the event of an emergency.
 
Current Gender


 
Birth Gender


 
Did you arrive in the UK as an asylum seeker or do you have refugee status?

     
 
Is English your first language?

     
 
Please tell us which is your first language

 
Do you receive Educational Maintenance Allowance (EMA)?

Education Maintenance Allowance (EMA) is a payment received by some 16-19 year olds depending on their household income. 

You can check your eligibility here: http://www.emascotland.com
     
 
Do you have a job?

This helps us understand if you have other commitments that may make it more difficult for you to attend our activities
     
 
Has anyone in your household i.e. parent/guardian or siblings attended university before?


 
Are you/ or have you been in care? *

This includes anyone who has been adopted, or in foster care, local authority care or kinship care i.e. for instance living with a relative other than your parents or a close family friend.

We ask this question so that we can let you know what additional support you are entitled to, if you wish to take advantage of this. This could include finance, accommodation and other support services.


 
Are you a Young Carer?

Do you provide care for members of your family who are ill, elderly or young children?

We ask this question so that we can let you know what additional support you may be entitled to, if you wish to take advantage of this.

 
Do you have a disability?

It is important that we know about any disability, illness or health condition you have so that we can organise our activities in the best possible way.

 
How would you describe your nationality?


 
Which religion do you belong to?


 
How do you describe your ethnicity?


 
Terms and Conditions: 

By registering to join GSA Widening Participation programme, you understand and accept the following terms and conditions with regards to the use of your data:

• GSA will retain the details you have submitted on their database and details of events that you attend. 

• GSA staff will use the personal contact details you have provided to contact you with information about the project and related events. 

• Your data will be retained for a maximum of seven years and may be used for the purposes of monitoring and tracking. 

• GSA may liaise with other departments within the GSA about any future application you make and may share details of events you have attended.

• Your personal data will not be shared with any other third parties beyond our delivery partners (see below), although your school will be made aware that you have registered with Widening Participation at GSA. 

• Pupils and their work may be photographed and these photographs may be reproduced in promotional materials. *

As part of our widening participation programme, GSA works with a number of delivery partners and delivers activities as part of the ACES and FOCUS West national programmes. ACES and FOCUS West work to support an increase in pupils progressing to Higher Education from schools with the lowest progression rates. GSA and FOCUS West may therefore access key data from Skills Development Scotland to see how you do in your exams at school, at college and/or university and where you go from there. FOCUS West may contact you in the future to find out about your progress and ask for your reflections on the FOCUS West activities you participated in.
     
 
Parent/Guardian Consent

Please ensure that your parent/guardian reads the above terms and conditions and the statement below.

As the the parent/guardian of the above young person, I confirm that I have read and understood the notes set out in the terms and conditions and I hereby consent to him/her taking part in activities connected with the Widening Participation programme.

I consent to my son/daughter receiving such medical treatment as may be advised by a doctor in the event of an emergency. *

If you have any questions about the terms & conditions or Widening Participation activities, you can contact us at wp@gsa.ac.uk
     
Thank you for registering with Widening Participation. We look forward to working with you in the near future!

If you have any questions, please do not hesitate to contact us at wp@gsa.ac.uk
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