Professional Documents
Culture Documents
Universities Programme
The Excell3 Apex Universities programme aims to support underrepresented groups of students to
access Britains top Universities.
Raise students aspirations and confidence to apply to top universities including Oxford and
Cambridge
Provide academic master classes to help drive-up students attainment levels to improve
their chances of securing a top university place.
Provide information, advice and guidance about higher education (e.g. the application
process, the admissions interview etc)
Empower parents to support their child through the Higher Education process
Students accepted on this programme who have met our criteria in Year 12 will be given priority
to join our Oxbridge University programme.
4th, 2014
Student Details
Surname
First Name
Date of Birth
Home Address
Post Code
Telephone No.
Email
Please return your completed form along with (2) passport sized photographs of the applicant to:
Excell3, 6 Beacon Court, Birmingham Road, Great Barr, Birmingham, B43 6NN
For questions or enquiries please telephone 0121 3588620
Female
Sexual Orientation:
Bisexual
Gay/Lesbian
Heterosexual
WHAT IS YOUR ETHNIC GROUP? Tick the appropriate box to indicate your cultural background
(a)
(c)
(e)
WHITE
(b)
Caribbean
African
(d)
MIXED
British
Irish
Gypsy or Irish Traveller
Any other White background
please write in below
Indian
Pakistani
Bangladeshi
Chinese
Arab
Any Other or Mixed background
please write in opposite
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Religion or Belief:
Muslim
Sikh
Advertising:
Where did you learn about this project? _________________________________________________
School Details
Name of School
Type of School
Grammar
Independent
Comprehensive
School Address
School Telephone
Number
No
Parent/Guardian/Carer Details
First Name
Family Name
Relationship to
student
Address
Post Code
Email address
Telephone
Mobile
Why do you think your child would be suitable for this programme?
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In what ways do you feel you can support your child on this programme?
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What do you think could be potential obstacles that might affect your child in their advancement
towards higher education?
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School Reference
Full Name
Position
School Name and
Address
Telephone Number
Mobile
Email address
In what capacity do you know this student?
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Please provide a character reference for this student considering the qualities they possess their
contributions to the school community.
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Please comment on the students academic ability including Key stage 3 results and their predictions or
likelihood to achieve primarily grade As in their GCSE Exams.
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