Admin

DATA COLLECTION FORM: Post16

Who are we?

East Midlands Widening Participation Research and Evaluation Partnership (EMWPREP) is a collaboration of Higher Education providers that offers a targeting, monitoring and evaluation service for the outreach initiatives delivered by each partner. Detailed information on EMWPREP and how we collect and use the data can be found at: www.emwprep.ac.uk/privacy-notice

Why are we collecting this information?

You are taking part in a university or college activity. To make sure these activities are useful for you and other young people like you we need to gather some information (including information about your ethnicity and disability status), which will be analysed and used by EMWPREP and partners for research purposes only. This information also helps us demonstrate to funders, such as the Office for Students (OfS), the value and impact of the activities we deliver.

Will we share your data?

For research purposes we may share the data held on this form with the following receiving organisations:

our partner universities and colleges,
your school or college,
your college’s Local Authority,
third-party activity providers working with partner universities and colleges, and
third-party data processors working with partner universities and colleges.

What research do we do?

EMWPREP and the receiving organisations may then link data from this form to other educational data already held on you (including Department for Education data held on the National Pupil Database, your Individualised Learner Record data, UCAS records and/or HESA student records). We may access this data and use it to see if university or college activities have made a difference to your future progression.

From time to time we may publish reports on our research, all data will be nameless, and individuals cannot be identified. The data will not be used for any other purpose.

Do you want more information?

Data will be processed in accordance with the relevant data protection legislation. For more information, please see www.ico.org.uk/ or call 01509 223462.

Having read the above, we would be really grateful if you could take a few minutes to complete this form.

Completing the form

The form below is split into two sections, you can submit the form after completing student details or you can complete an expanded full form version.

* Required fields

Student details

First Name *

Last Name *

Birthdate DD/MM/YYYY *

Year group

Address1

Address2

Town

County

Postcode*

School/College Name *

Targeting and monitoring

What best describes the gender you identify with?

Have any of your parents or carers studied at a university or taken a degree?

Have any of your siblings, aunties/uncles or cousins studied at a university or taken a degree?

Have you been eligible for Free School Meals at any time in the last six years?

Have you been in care?

Please select Yes if:

You have spent any time living in public care as a looked after child including in local authority care and living with foster carers or in a children's home
You have been 'looked after' at home under a home supervision order in Scotland

Please select No if:

You have not spent time in care.

Please note this does not refer to time spent working in a care or healthcare setting or if you are or have been a carer for a relative.

Do you consider yourself to be a young adult carer?

Please select Yes if:

You are a young person who cares, unpaid, for a family member who due to illness, disability, a mental health problem or an addiction cannot cope without your support.

Would you consider yourself estranged from your family?

Please select Yes if:

If you no longer have the support of your family due to a breakdown in your relationship and you have ceased contact with them.This might mean your biological, step or adoptive parents, or wider family members who have been responsible for supporting you in the past.

Did either of your parents or carers serve in the Armed Forces or reserves during your childhood?

What best describes your ethnicity?

What best describes your status?*

Do you have a disability?

Disabilities

Future contact

On occasion EMWPREP and/or receiving organisations may wish to contact you and invite you to participate in additional research about activities you have taken part in.

I agree to be contacted to be invited to take part in additional research

To sign up to receive further information from University of Derby [10007851] including emails containing information, advice and guidance about future education options please provide details below. (These details will NOT be passed to any third parties other than the CRM provider).

I would like to receive further information from University of Derby [10007851]

To be sent to the following email address:

Your name (by writing your name you are consenting to being contacted as described above): * (required if further information to be received)

Date: