Fillable Application Form & Programme Overview Application Process and (University of Bedfordshire)

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Application Form & Programme Overview Application Process and (University of Bedfordshire)

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  • 64 check-boxes
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Country of origin: UK
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Go Global Application & Programme Overview
1
1. All completed application forms must include a copy of the passport that you
will be travelling on and a copy of the deposit receipt for £100 and will not be
accepted without these.
2. All applicants will be informed of the outcome of their application by e-mail.
3. All successful applicants will be contacted by email with further details on when to
make their full payment.
4. Once your flight and hotels are booked, refunds are issued on a case-by-case basis
which will be decided by the Deputy Vice Chancellor.
Please note: There are no guarantees that you will receive a refund.
Application Form &
Programme Overview
I confirm that I have read and understood the application process.
Student Name _____________________________________________________
Student Signature ___________________________ Date _________________
All students will be required to apply for their own visa (if applicable) and travel insurance
to participate in a Go Global trip (further information will be provided to successful
students).
You will require the following for the application process:
1. Valid Passport (expiry date must be valid at least 6 months after the end of your trip).
2. 1 Passport Photo.
3. Sufficient fees.
4. Individual Travel Insurance.
I confirm that I have read and understood the visa process.
Student Name _____________________________________________________
Student Signature ___________________________ Date _________________
Contact: Please contact goglobal2019@beds.ac.uk for further information about the
programme and how we process your data.
Please state which trip you wish to join _________________________________
Application Process and Deadline
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Go Global Application & Programme Overview
2
University of Bedfordshire Go Global Trip Application Form
Name:
Student ID:
Course:
Date of Birth:
Home Address:
Term-time Address:
Male Female Other
Personal Email address:
Home Phone number:
Mobile number:
Next of kin 1:
Relationship:
Address:
Contact number:
Please
attach your
photograph
here
Next of kin 2:
Relationship:
Address:
Contact number:
Gender:
Go Global Application & Programme Overview
3
I consent to the University of Bedfordshire’s use of my personal data, including sensitive
data, to allow the University to fulfil its administrative obligations and to process my
application. The University shall duly observe its obligations under the General Data
Protection Regulations and any resulting legislation which arise from this application.
The information I provide on the application form will be used for the following purposes:
• To determine eligibility to join the University of Bedfordshire Go Global Programme.
• To provide me with relevant information to assist me in joining the Go Global
Programme (e.g. information about accommodation, visa advice, travel
arrangements, itinerary whilst in country.
• I consent for my medical details and next of kin information provided in this
application form to be shared with medical staff, University staff accompanying the
trip and University staff based in the UK, as well as partner universities in the country
I am visiting where no University of Bedfordshire staff member is accompanying the
trip) should I become ill and need medical treatment whilst in the country and am
unable to advise relevant medical personnel myself.
I consent to the University sharing this information;
• With the relevant Government departments, e.g. The Embassy, to arrange a visa
application on my behalf.
• Where applicable, with accommodation provided, arranged through the University’s
approved in-country partners’ accommodation and visa system.
• Travel agents who arrange on behalf of the University to provide students and staff
with flights to and from the UK and the country that they have been successfully
accepted to travel to under the Go Global programme.
• University staff supporting and accompanying students and UK-based University staff
The University will retain my personal information for the rest of the academic year for
which I have applied, plus one further academic year. My data will be managed as per the
student agreement which I will sign below.
Signed ______________________________________________
I hereby certify that all of the information on this form is correct and complete, and I wish to
apply for the Go Global Programme as a student of the University. I also declare that, if
accepted onto the programme I shall conform to all the Rules and Regulations of the
University of Bedfordshire. I understand that the submission of any misleading information
during the application process could lead to the immediate cancellation and/or withdrawal
of my application.
Signed ______________________________________________
Declaration
Data Protection
Go Global Application & Programme Overview
4
Academic Tutor Reference
Please provide a reference from your current course leader/lecturer/supervisor with
University of Bedfordshire.
Referee Name: ____________________________________________________________________
Referee Job Title: __________________________________________________________________
Contact Tel. No: ___________________________________________________________________
Contact Email: ____________________________________________________________________
Academic Reference Declaration
I agree that the student named on this form is currently in good academic standing, they
have passed their assessments/exams/projects to date and are currently working at a level
adequate to pass the academic year. I also confirm they will not be required to be on
placement or participate in any academic activities (i.e. field work) for the duration of the
trip.
Signed ________________________________ Date ____________________________
Go Global Application & Programme Overview
5
Supporting Personal Statement
Have you taken part in the Go Global Programme in previous years?
YES NO
If yes, what year did you attend and what was the destination?__________________________
Personal Statement
Please use the space below for your personal statement, which must explain why you
should be considered for the trip. There are three questions that MUST be answered in your
statement;
1. What do you know about the destination and way of life there?
2. Why should you be chosen to go on the trip?
3. How will you use this experience to enhance your employment and social
opportunities locally and globally?
(Minimum 250 words - please attach a separate sheet of paper if needed)
Go Global Application & Programme Overview
6
Dear Student,
Important - please note:
The University of Bedfordshire is supportive of students with disabilities joining the trip,
and year-on-year we are making adjustments to assist students with disabilities. If we can
identify your needs in advance of the trip then we will be able to put the appropriate
arrangements into place for you.
If you have not told us about your disability:
While we make all reasonable adjustments to our provision, we may not be able to meet
your individual needs if we do not have the opportunity to asses them in advance, and that
could impact negatively on your experience or even your ability to take up your place on the
trip.
If you have told us about your disability:
You may be asked for additional information or invited to attend an interview with the
Disability Team. This is so that we can properly assess your individual needs and
ensure that we have the best possible chance of meeting them. Please do provide any
information that is requested and come in to see staff if asked, otherwise you - and we -
could find ourselves in a position in which it is difficult or even unsafe for you to take up
your place on the trip.
Disability Notification
Do you have a disability registered with University Of Bedfordshire?
Are there any health related issues that could impact on your travel?
If Yes, please give details of your condition below.
YES
YES
NO
NO
Go Global Application & Programme Overview
7
Go Global Medical Authorisation
Student Name _______________________________________ Student number ______________
Destination__________________________
As part of Go Global, I understand that I have to take out travel insurance for the duration of
the trip. I also understand that this information could be shared with a hospital or medical
service if I am unable to give it to them myself.
I understand that my next of kin could be informed of an illness or injury by senior
Go Global University of Bedfordshire staff if I am unable to do so myself.
I confirm that the University of Bedfordshire will not be responsible for my decision to
decline medical advice should it be given to me and I decide not to act upon it.
I confirm that I will contact my family and inform them of my rejection of medical advice
and will inform the trip leader and Go Global management that I have done so.
I confirm that I will contact my insurance company and inform them of the medical advice
given to me and my response to advice given.
I confirm that the University of Bedfordshire reserve the right to contact my family if the
need arises over specific concerns regarding my health or the rejection of medical advice
given to me.
Signed _____________________________________
Printed _____________________________________
Date________________________________________
Go Global Application & Programme Overview
8
How we use your details:
Details given on this form may be shared with medical staff, University staff accompanying
the trip, and University staff based in the UK, as well as partner universities in the country
you are visiting, where no University of Bedfordshire staff member is accompanying the
trip, should you become ill and need medical treatment and are unable to advise relevant
medical staff yourself.
MEDICAL DETAILS
Please complete the following medical questionnaire to the best of your ability, by marking
an X in the relevant box. Please note that for certain conditions i.e., mental health
conditions and pregnancy, we would require written approval from your GP allowing you to
travel.
Do you have or have you had in the past: Ye s No
If YES, please give details of any
treatment/medication you are taking
Angina, raised blood pressure or other heart
problems?
Eyesight problems not corrected by glasses/
contact lenses? E.g restricted vision, glaucoma, etc.
Hearing problems not corrected with a hearing aid
such as restricted hearing, tinnitus, or ear
infections?
Are you taking or are you being given any
medicines, inhalers, injections or eye/eardrops at
the present time?
Any difficulty in standing, bending, lifting or other
movements?
Any kind of back problem?
Any kind of neck or shoulder
problem?
Any problems with your joints including pain,
swelling and stiffness? For example, arthritis,
rheumatism, upper limb disorder, tennis elbow etc.
(WOMEN ONLY) Are you pregnant or have you had
a child in the last 6 months?
Bronchitis, pleurisy, tuberculosis, coughing up
blood, shortness of breath or other chest problems
(within the last five to ten years)?
Any fits, blackout, fainting or epilepsy?
Diabetes?
Asthma?
Depression, stress, anxiety or other mental health
problems such as panic attacks, sleep deprivation
which have caused you to seek medical advice?
Go Global Application & Programme Overview
9
Do you have or have you had in the past: Ye s No
If YES, please give details of any
treatment/medication you are taking
Migraines or persistent headaches?
Any conditions or therapies that could affect your
immune system, e.g. Leukemia, Sickle Cell, and
AIDS, HIV infection, radiotherapy or chemotherapy?
Hepatitis, jaundice or liver disease?
A bleeding problem or bleeding disorder?
Any Circulatory or Respiratory Diseases?
A drug or alcohol problem including drug or alcohol
usage?
Vertigo or Altitude sickness?
Allergies (Nuts/ Penicillin/ Wasp or Bee stings/Shell-
fish or other?)
Any skin problems? E.g. eczema, dermatitis,
psoriasis, recent infection or skin cancer?
Have you had any hospital treatment in the last 6
months?
Are you due to have any hospital treatment in the
next 6 months?
Do you have any other medical conditions?
Name and Address of General Practitioner (GP)
Signature of Student ________________________
Date________________________________________
I confirm that:
• I understand that I may incur costs e.g. for a health check, or for a visa as part of the
application process
• I understand that, if traveling with the University, I will need to behave in a manner
that will not bring the reputation of the University Of Bedfordshire into disrepute.
Telephone No:
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Go Global Application & Programme Overview
10
Special Dietary Requirements
This section will notify us if you have any strict dietary requirements that are essential to
your health, wellbeing or religious beliefs. So that we can accommodate your dietary
requirements, please complete this section.
Gluten Intolerant
Lactose Intolerant
Vegan
Vegetarian
Diabetic
Halal
Kosher
Hindu
No special meal required
Allergies
Nuts
Dairy
Shellfish/ Seafood
Other
No allergy
Go Global Application & Programme Overview
11
Student Name_____________________________________________________________________
Student ID________________________________________________________________________
As part of Go Global, I confirm that I have read and understood the following:
1. If after paying the full amount and confirming that I can travel, I then decide to pull
out of Go Global for any reason, the fee is non-refundable.
2. I am responsible for my own visa fee, and if my visa is refused by the Embassy,
this is out of the control of the University of Bedfordshire and no refund will be given.
3. I must be able to fund all aspects of the trip: trip fee, visa fees (where required),
spending money and travel insurance.
4. Payments made for/on the trip must not be connected to any illegal act by me.
Signed _____________________________________
Printed _____________________________________
Date________________________________________
Go Global Application & Programme Overview
12
Go Global Ambassador Behaviours
Student Name_____________________________________________________________________
Student ID________________________________________________________________________
Destination________________________________________________________________________
As part of Go Global, I understand that during this trip I will be an ambassador of the
University of Bedfordshire and as such, I will behave responsibly at all times and will show
respect to my fellow students and to staff and students of the partner institution in the
country. Furthermore, I give an undertaking that I will respect local customs and local
people and obey the laws and regulations of the country.
I fully understand that the rules of the Go Global visit require me to attend all classes, local
trips and events. I hereby give my commitment to follow those rules, to arrive on time and
to undertake any pre-preparation that is required. In addition, if I find during the trip that I
have any worries or concerns, I will be polite and respectful in my questioning at all times
and raise the issues to the member of staff or the group, as was instructed in the pre-visit
information.
I confirm that the University of Bedfordshire will not be responsible for my behaviour
during the trip. However, should behavioural concerns arise, Go Global partners will inform
University of Bedfordshire staff.
I confirm that the University of Bedfordshire reserve the right to contact my family if the
need arises over specific concerns or in the case of serious breaches, to send me home
early at my own or my family’s expense.
Should a serious breach or complaint be raised in regards to my behaviour whilst on the
trip, I will be required to explain my behaviour to the Vice Chancellor/Deputy Vice Chancellor
upon my return to the UK. This may result in further consequences which could effect my
registration/further studies at the University.
Signed _____________________________________
Printed _____________________________________
Date________________________________________
Go Global Application & Programme Overview
13
Go Global Employabilty Unit
I understand that there is a Go Global Employability Unit as part of the Go Global
programme. The benefit of this unit is to make me more globally employable and help
enhance my CV.
Upon passing this unit I will receive a £50.00 refund.
I fully understand that should I not pass the unit or a complaint is raised in regards to my
behaviour whilst on the trip, I will not receive a refund. (PLEASE REFER TO GO GLOBAL
AMBASSADOR BEHAVIOUS, PAGE 12).
Signed _____________________________________
Printed _____________________________________
Date________________________________________
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Completed 11 October 2020

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