Please complete the following form to apply for a place on a 5-Day SPARQ-ed Immersion

Student Details

Contact details

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* 1. Contact details

School attended

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* 2. School attended

Gender

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* 4. Gender

Date of birth (note you must be 15 years old at the time of the Immersion to participate)

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* 5. Date of birth (note you must be 15 years old at the time of the Immersion to participate)

Birthday
Student alternative email address

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* 6. Student alternative email address

I wish to identify as:

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* 7. I wish to identify as:

Select Program Dates
Program dates- all dates are subject to research teams availablility, project topics, and will be confirmed early in 2018 for the 2018 immersions).

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* 8. Program dates- all dates are subject to research teams availablility, project topics, and will be confirmed early in 2018 for the 2018 immersions).

  1st choice 2nd choice
2018:  9-13 April (Commonwealth Games week)
Years 11 and 12 only
2018:  2-6 July
Years 10, 11, 12
Residential regional and remote student Immersion (min age 15 years) - accommodation UQ College
2018:  9-13 July UQ special event
Years 10, 11, and 12
Residential regional student Immersion (min age 15 years) - accommodation UQ College
2018:  17-21 September (Last week of term 3)
Years 10, 11, and 12
2018:  24-28 September
Years 10, 11, and 12
2018:  2-5 October
Years 10, 11, and 12
2017 only 27 November – 1 December (Years 10 and 11 ONLY)
2018: 3-7 December
Years 10 and 11 only
2017 only 4-8 December (Years 10 and 11 ONLY)
2018: 10-14 December
Years 10 and 11 only
Parent Details
Parent/Guardian Contact Details

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* 9. Parent/Guardian Contact Details

Parent/Guardian contact phone number

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* 10. Parent/Guardian contact phone number

Parent/Guardian email address

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* 11. Parent/Guardian email address

School Details
Contact teacher details (teacher you will ask to write your recommendation)

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* 13. Contact teacher details (teacher you will ask to write your recommendation)

School information

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* 14. School information

School type

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* 15. School type

School Location

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* 16. School Location

Student Academic Results
Science-relevant subjects only. Biology, Chemistry or Both must be included
Subject #1

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* 17. Subject #1

Subject #2

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* 18. Subject #2

Subject #3

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* 19. Subject #3

Subject #4

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* 20. Subject #4

Subject #5

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* 21. Subject #5

SPARQ-ed Bonus Rank Program (Optional)

The SPARQ-ed Bonus Rank Program allows participants in the research immersion programs to complete an additional component which awards them a bonus point under the University of Queensland Bonus Rank Scheme. Information about this program can be found at http://www.di.uq.edu.au/sparqedbonusrank

I have read the information about the SPARQ-ed Bonus Rank Program and am aware of the additional activities required of me. I would like to take part in this optional activity and be considered for a bonus point under the University of Queensland Bonus Rank Scheme.
I would like to take part in the optional Bonus Rank Program

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* 22. I would like to take part in the optional Bonus Rank Program

If Yes: Learner Unique Identifier (LUI):

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* 23. If Yes: Learner Unique Identifier (LUI):

Student Interest Statement (max 500 wds)
Please write a short statement on what qualities you can bring to the SPARQ-ed Research Immersion Program, citing examples where possible. Explain why you want to take part in the program and detail any areas of special scientific interest you may have:

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* 24. Please write a short statement on what qualities you can bring to the SPARQ-ed Research Immersion Program, citing examples where possible. Explain why you want to take part in the program and detail any areas of special scientific interest you may have:

Activity Log

Please detail any relevant scientific experience you may have already completed. This may include part-time work, work experience, volunteer work, and other science programs (e.g. Siemens Summer School, Frontiers in Science lectures, Optiminds, Science & Engineering challenge, Science Competitions etc.).
Activity #1

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* 25. Activity #1

Activity #2

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* 26. Activity #2

Activity #3

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* 27. Activity #3

Activity #4

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* 28. Activity #4

Thank you for your expression of interest. You will be given an opportunity to apply for your preferred Immersion before it is opened up to other students.

Please note: You will still need to meet the academic achievement requirements to be considered by the selection panel.

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