exscitec

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Please provide details of your child

* First Name:

* Last Name:

* Position: Student Parent/Guardian Teacher Other (please specify)

Other Position:

* Gender: Male Female

* School:

Local Authority:

* Year Group

(Hold Ctrl to select multiple)
e.g. a teacher may enquire about activities for several year groups: Key Stage 1 Key Stage 2 Key Stage 3 Key Stage 4 Key Stage 5 Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 Year 9 Year 10 Year 11 Year 12 Year 13

* Email Address:

* Telephone Number:

Student Home Address1:

Student Home Address2:

Student Home Address3:

Student Home County: Bedfordshire Berkshire Buckinghamshire Cambridgeshire Cheshire Cornwall Cumberland Derbyshire Devon Dorset Durham Essex Gloucestershire Hampshire Herefordshire Hertfordshire Huntingdonshire Kent Lancashire Leicestershire Lincolnshire London Middlesex Norfolk Northamptonshire Northumberland Not Set Nottinghamshire Oxfordshire Rutland Shropshire Somerset Staffordshire Suffolk Surrey Sussex Warwickshire Westmorland Wiltshire Worcestershire Yorkshire

Student Home Postcode:

• If you are a school student, please indicate if you
  are registered on either of the following lists?
• Aim Higher
• Gifted & Talented
•  
• * required fields

Below is for OPTIONAL additional detail, useful for
improving the accuracy of our reporting

Where did you hear about Exscitec?

Have you participated on Exscitec/Imperial College London Events/Schemes in the past?

If yes, please state what and when:

Any other comments:

Course Enquiry

Please use the enquiry form to tell us the course(s) that interest you. We will update you with further information as it becomes available:

(Hold Ctrl to select multiple): Biology Master Classes - half-day sessions Chemistry at Work Chemistry Master Classes - half-day sessions Chemistry Synthesis and Investigation (CSI) Days (in-school) Clothworkers' Maths Bursaries Clothworkers' Maths Summer School Colourful Chemistry Cosmetics Chemistry Diagnosis of an Unknown Disease Entrepreneurial Bioscience FIRST Robotics Competition G&T STEM World Summer School- non-residential G&T STEM World Summer School-Residential KS3 STEM live! MathMatters Maths Master Classes - half-day sessions Medical Sciences Summer School Medical Sciences Taster Day Nuffield Science Bursaries Physics Master Classes - half-day sessions Post-16 Maths Preparatory Summer School Primary Science Investigation - INSET Robotics Summer School Robotics Workshops Science Stars (KS4) Student Associates Scheme Sutton Trust Mathematics Summer School Triple Science Master Classes: Chemistry, Biology and Physics Year 10 STEM Summer School Year 11 STEM Summer School

Any other questions, comments, or detail about the types of STEM activities that interest you:

Course Application

To apply for a course/scheme, select your choice from the menu to complete the form. The menu will show all courses and schemes for which there is an online registration form:

(Hold Ctrl to select multiple) Biology Master Classes - half-day sessions Chemistry Master Classes - half-day sessions Clothworkers' Maths Bursaries Maths Master Classes - half-day sessions Nuffield Science Bursaries Physics Master Classes - half-day sessions Robotics Summer School Science Stars (KS4)

By submitting this form you are consenting to the details you provide being held on the Exscitec database (please contact us at any time if you wish us to remove your details from the database)

We require your explicit consent to process the data you have provided, which is retained in accordance with the principles as set out in the UK data protection act (1998). Exscitec may be required to share appropriate data only with third parties directly involved in the organisation of activities in which you have expressed an interest. You may request that we remove your data at any time.

 Please tick this box to confirm that you give consent for the above use of this data
We cannot process this application without your consent.