Student Questionnaire

Student name *

Preferred name

Student's email

Please make sure this is the student's email address. A student's pack will be sent to this address.

Date of birth *

Tshirt size *

Campus *

Personal

This section should be filled in by parents and students together.

Please note all information provided is confidential and will only be shared with those who need to know within ISSOS. We do however need to know EVERYTHING that may affect students during their time with us.

All information given is to assist us in making sure your son/daughter has the best possible experience.

Any relevant fears, phobias or allergies (not including dietary - see below).

(Please be assured all information will be handled with great care and confidentiality)

Are there any circumstances, issues or personal/family issues that we should know about or that may affect you while at ISSOS?

Does the student have any dietary requirements we should be aware of? If so please provide details.

Will you follow any religious festivals or practices?

If yes, please provide details

Medical

Are there any circumstances (physical, mental, or emotional) in the student's medical history that you feel we should be aware of? If so, please specify.

Will the student be bringing/taking any medication during the summer school? *

Please tick if the student has any known reactions to the following drugs:

Penicillin
Antibiotics (please give details, including type)
Aspirin
Other (please give details)

As guardian of the named students I give consent to have the above named student treated by emergency medical personnel, a physician, or surgeon, in case of sudden illness or injury while participating in activities in relation to the summer program. It is understood that ISSOS will not provide any medical insurance for the above named student for such treatment and that the above named student will have appropriate medical insurance to cover all medical expenses while at ISSOS.

I as legal guardian give authorisation for the above named student to self-administer all prescription medication detailed above.

Doctor Information

Name and address of Family Doctor *

If you have no family doctor, please note this and add your own telephone number below

Doctor Telephone (in case of emergency) *

As guardian of the named students I can confirm that the above named doctor has agreed that the student is in good health and fully able to participate in all activities of ISSOS Summer Schools and I know of no restrictions, physical impairments or any other facts which would limit their participation.

Please confirm that the student is covered or will be covered with adequate medical and travel insurance to cover all medical care while at ISSOS.

Illness and Allergies

If other, please specify:

Will the student bring any medication/Epi Pen etc. to assist with this allergy: *

Please give details (Including frequency of seizures and last known seizure information):

Academic Program

Please note that these questions aim to give us an indication of the student's academic experience, ability and goals.

General

School year which student will enter after summer?

Does the student have any learning difficulties we should be aware of? If so please specify.

Student's academic program choice

English Language Program

What is your native language?

How many years have you been learning English?

Which skills would you most like to improve? (speaking, reading, writing)

Which of the following best describes your level of English?

Youth Leadership

In 50 words or more - why have you chosen youth Leadership?

What does Leadership mean to you?

What are you hoping to gain/achieve from Youth Leadership?

What personal qualities do you feel you can bring to Youth leadership and what personal qualities would you like to develop?

Pre IB

If other, please specify

Have you taken part in the IB Middle Years Program?

Please note that you are of course welcome to bring as many of your school materials as you wish, though you should note that you will be working in a University level library containing a huge volume of academic resources.

Extended Essay

Please detail your extended essay topic and title

What stage are you at with the essay?

If other, please specify

Creative Writing

Why have you chosen Creative Writing?

Business and Entrepreneurship

If other, please specify

Why have you chosen Business and Entrepreneurial Studies?

What do you hope to gain from taking this class?

What is your understanding of the term entrepreneurship?

Debate

Please name any specific goals/objectives for your debating (e.g. speaking, logic, general knowledge, confidence)

Have you taken part in Public Speaking, Debating etc before?

If yes, please give details:

Study Skills

If other, please specify

Journalism

In 50 words or more why have you chosen Journalism?

What skills are you interested in improving/learning?

Research
Writing
Editing
Interviewing

If other, please specify

Electives

Student's elective choice

Golf

How would you class your golfing ability/experience?

Do you have a handicap?

If so, what is it?

Do you play left or right handed?

Do you have any specific goals/objectives for your golf coaching this summer?

How long have you played golf?

Are you bringing your own golf clubs?

Please note that all clubs are provided. However, if you prefer to play with your own clubs feel free to bring them.

Tennis

How would you class your tennis ability/experience?

Do you have any specific goals/objectives for your tennis coaching this summer?

Are you bringing a racket?

Please note we recommend students bring your own racket. However, we do have limited rackets available for those who do not have one.

Theatre

Do you have any previous experience of participating in theatre? If so please give general overview:

If other, please specify:

Film

Do you have any previous experience of filmmaking? If so, please give a general overview:

Are you familiar with film editing equipment or software? If so please specify:

Have you ever operated a digital video camera?

Please note that if you have any films that you have previously made or scripts that you have written we would love for you to bring these along.

Art

Why have you chosen Art?

What type of art are you interested in?

What skills are you interested in working on this summer?

Photography

Which of the following best describes the student's level of Photography?

Do you have previous experience in photography? If so please give details?

Confirm make and model of the camera you will be bringing?

Note: Smart phones are not acceptable; students must have a digital camera ideally with a manual focus option.

Do you have any experience with any editing software eg. iphoto or Photoshop?

Will you be bringing a laptop?

What would you like to get out of the course?

Describe your motivation for taking part in this course:

I don't know much about photography but I'd like to give it a try
I've spent a little time experimenting with photography and I'd like to develop more skills
I'm passionate about photography as an art form and know how to use my camera pretty well
I'm confident with most of my camera's functions but I'd like to learn more about it's uses, history, advanced techniques and a potential career in the field

Outdoor Leadership

Why have you chosen Outdoor Leadership?

If other, please specify:

Fencing

Have you fenced before?

What kind of fencing have you done before?

If yes, for how long and to what level?

Activities

To be filled out by all students.

Are they a confident swimmer? *

If other, please specify:

Students get the opportunity to go on several day trips during their time here. Please indicate which trips you are most interested in going on by ranking them in order of preference. "1st" means the trip you most want to go on.

Trip preferences

	1st	2nd	3rd	4th
Glamis Castle
Water Sports
Scottish Deer Center
Ely Cathedral
Imperial War Museum
Scone Palace
Birds of Prey Sanctuary
Yale University Tour
Peabody Museum of Natural History
Connecticut Science Centre

Are there any reasons why the student cannot or may choose not to partake in any of our sporting or evening activities? *

If yes, please specify:

Does your student play a musical instrument? *

We would encourage students who play musical instruments to bring them if they are easy to travel with and they are interested in being involved in a summer school band or for the talents show etc

Please let us know what you wish to gain from this summer experience and any additional requirements/requests or suggestions you would like to make. We offer a very flexible program and would welcome any comments or requests regarding evening programs/trips etc (we cannot guarantee these will be granted but we will do our best to include as much as we can).

Other information

By submitting this form, ISSOS will process the data you provide in accordance with our Privacy Policy.

Student Questionnaire

Personal

Medical

Medication

Doctor Information

Illness and Allergies

Academic Program

General

English Language Program

Youth Leadership

Pre IB

Creative Writing

Business and Entrepreneurship

Debate

Study Skills

Journalism

Electives

Golf

Tennis

Theatre

Film

Art

Photography

Outdoor Leadership

Fencing

Activities

Academics

Electives

Activities

	1st	2nd	3rd	4th
Natural History Museum
St Patricks Cathedral
Museum of Modern Art
Times Square