Junior Emergency Medicine (JEM) In 'Outreach and Widening Participation' Junior Emergency Medicine (JEM)Outreach and Widening ParticipationYear 10Year 11Year 12Year 13Widening Access to MedicineBirmingham Widening Access to Medical Sciences (BWAMS)Work ExperienceNews and Past Events Back to 'Medical and Dental Sciences' JEM is a one-day introduction to emergency medicine for Year 11 students who may be interested in studying medicine, nursing or an allied health profession. The event takes place on Saturday 18th November. Run by medical and nursing students it will give you hands-on experience of being part of a simulated emergency assessment team, you will undergo simulations similar to those used to train healthcare students and you will gain practical skills to support you in making an application to University in the future. Applicants from families with no previous experience of higher education and from areas with low progression to higher education will be prioritised for places on this scheme. Before completing this form, please ensure you have read the accompanying JEM leaflet. If you have any further questions please contact Dr Clare Ray (email@example.com), College of Medical & Dental Sciences lead for Outreach and Widening Participation. This form has two sections: SECTION 1 - All about you, to be completed by the applicantSECTION 2 - Consent and information, to be completed by the parents/guardians/carers Both sections of the form need to be completed for your application to be considered. Section 1 - All about you Name First name Last name Home Postcode: Email Address: Gender: MaleFemaleOtherPrefer not to say Your month and year of birth: Name of School/Academy/College: Post code of School/Academy/College: Which ethnic group do you belong to: White BritishWhite IrishWhite OtherAsian IndianAsian PakistaniAsian BangladeshiAsian OtherChineseBlack CarribeanBlack OtherMixed White and Black CarribeanMixed White and Black AfricanMixed White and AsianMixed OtherPrefer not to sayOther Your choices: MedicineSurgeryNursingPharmacyOther Please Indicate which medical science you are interested in (you may tick multiple) Why are you interested in pursuing the medical sciences as a potential career option (max 100 words)? Please provide a brief statement outlining what you wish to achieve as a result of attending this course (max 100 works) By typing your name below I confirm I am able to attend the JEM event on Saturday 18th November. Please PRINT your name here. Section 2 - Your parent/guardian/carer Parent/Guardian/Carer 1 - Name: First name Last name Relationship to Applicant: Highest qualification (Please tick the highest qualification you have achieved): NoneGCSE/O LevelA Level/BTEC/NVQ L3HNC/HNDFirst Degree (BA, BSc)Higher Degree (MA, PGCE, PhD)Other Contact Phone Number: Email Address: Preferred method of contact in case of emergency: Parent/Guardian/Carer 2 - Name: First name Last name Relationship to applicant: Highest qualification (Please tick the highest qualification you have achieved): NoneGCSE/O LevelA Level/BTEC/NVQ L3HNC/HNDFirst Degree (BA, BSc)Higher Degree (MA, PGCE, PhD)Other Contact Phone Number: Email Address: Preferred method of contact in case of emergency: Does your child have a disability and/or learning difficulty? (If yes, please give more details below) YesNo Is your child eligible for free school meals - even if this is not taken up? YesNo I/we the parents/guardians/carers give permission for the participant to attend: YesNo NB: If you tick 'No' to the above then we will not be able to accept your application. I/we the parents/guardians/carers give consent for the participants image to be used for publicity materials: YesNo NB: If you tick 'No' to the above you will need to provide a named passport sized photograph Print Name: Date Submit Deadline for applications: Friday 3rd November at 17:00 The applicants will be informed whether or not they have a place to attend JEM (on Saturday 18 November) by Wednesday 8 November at the latest. Successful applicants will be provided with information about where to arrive to at the Medical School and the timetable for the day via the e-mail address provided by the applicants above – please make sure that you check this e-mail Inbox regularly for updates.