2017

Entry

PART-TIME DEGREES

APPLICATION FORM

PLEASE COMPLETE IN BLOCK CAPITALS AND BLACK INK

Title: / Date of Birth:
Last Name: / Age on 1 Sept 2017:
First Name(s): / Where did you hear about the Programme?
Previous Surname (if applicable):
Address:
/ Nationality:
How long have you lived in the UK?
Telephone: / Email:
Please indicate the degree course in which you are interested. If you are interested in more than one degree please indicate them in order of priority.
Degree / Priority
Classical Civilisation/Ancient History & Classical Archaeology
English and Cultural Studies
French Studies
Health and Social Policy
History
Social Studies

EXEMPTIONS/ADVANCED STANDING

We are happy to consider requests for exemptions from modules on the basis of academic or professional qualifications. If you wish to be considered please complete the APL Form located at: http://www2.warwick.ac.uk/services/aro/dar/quality/categories/courseapproval/apel/

PREVIOUS EDUCATION

Please provide details of all schools, colleges and universities you have attended (from secondary education)
Name of school/college/university: / Dates:

QUALIFICATIONS

Please list your examinations, professional qualifications and any training taken or currently being followed (copies of certificates must be enclosed in order for your application to be processed)

Exam Type (eg GCSE, GNVQ, City and Guilds) / Subject / Date / Result/Grade
PLEASE LIST ANY QUALIFICATIONS FOR WHICH YOU ARE CURRENTLY STUDYING
Course/qualification/establishment / Subject / Expected completion date

PREVIOUS EMPLOYMENT EXPERIENCE, IN DATE ORDER, UP TO THE PRESENT

Dates / Name of Employer / Position

REFERENCES

The University requires either one academic reference (from a tutor at college or someone else who has taught you in a formal setting) or two character references from people who know you well. You should not ask a member of your family, but an employer, colleague, or other professional person would be suitable.

Please give each of your referees a copy of the reference notes. Ask your referees to put their reference in a sealed envelope, sign over the seal, and give the reference to you. Please return your completed application form along with reference(s) to the University of Warwick with your completed application form.

PERSONAL STATEMENT

Please write about 500 words explaining why you would like to study for a degree. You should cover the following themes:

·  Why you have chosen this degree

·  How studying for a degree will relate to your interests and/or work

·  Any activities that you are currently involved in (e.g. work, voluntary or family responsibilities)

·  How your work or other experiences have prepared you for further study

·  Which topics are of particular interest and why

·  Any reading or activity you have already undertaken in your proposed area of study

·  Your interest in books, films, theatre, music, sport and hobbies

Please continue on a separate sheet if necessary and then turn over to complete the Equal Opportunities Questionnaire and Declaration.

EQUAL OPPORTUNITIES

The University of Warwick and its partner colleges are committed to a policy of equal opportunities and will not discriminate against any applicant or student on the basis of age, gender, nationality, ethnicity or religion. Please help us to make our equal opportunities policy more effective by ticking the boxes below.

Arab ¨ Asian or Asian-British Bangladeshi ¨

Asian or Asian British-Indian ¨ Asian or Asian British-Pakistani ¨

Black or Black British-African ¨ Black or Black British-Caribbean ¨

Chinese ¨ Gypsy or Traveller ¨

Mixed – White and Asian ¨ Mixed – White and Black African ¨

Mixed – White and Black Caribbean ¨ Not known ¨

Other Asian background ¨ Other Black background ¨

Other ethnic background ¨ Other mixed background ¨

White ¨

Gender Male ¨ Female ¨
If you do not wish to disclose this information, please tick here o

Religious Belief

Buddhist ¨

Christian ¨

Hindu ¨

Jewish ¨

Muslim ¨

Sikh ¨

Spiritual ¨

Any other religion or belief ¨

Information Refused ¨

Sexual Orientation

Bisexual ¨

Gay man ¨

Gay woman/lesbian ¨

Heterosexual ¨

Other ¨

Information Refused ¨

PARENTAL EDUCATION

The following question is about your parents’ level of education. This includes natural parents, adoptive parents, step-parents or guardians who have brought you up.

Do any of your parents (as defined above) have any higher education qualifications, such as a degree, diploma or certificate of higher education?

Yes ¨ No ¨ Don’t know ¨ Information refused ¨

ADDITIONAL NEEDS

We welcome applications from candidates with additional needs and consider them on the same academic grounds as those of other applicants. It is helpful to know in advance if you have any special requirements and the Senior Tutor’s Office will be pleased to help assess your needs (024 765 23761).

Are you registered disabled? Yes ¨ No ¨

Do you have a disability/additional needs/medical condition? Yes ¨ No ¨

If yes, please tick the relevant boxes:

¨ Autistic Spectrum Disorder ¨ Mental health difficulty

¨ Blind/partially sighted ¨ Asperger Syndrome

¨ Deaf/hearing impairment ¨ Personal care support required

¨ Multiple disabilities ¨ Wheelchair user/ mobility difficulties

¨ Other disability

¨ A specific learning difficulty, e.g. dyslexia

¨ An unseen disability (e.g. Diabetes, epilepsy, asthma)

¨ Other additional needs (please specify below)

DECLARATION OF CRIMINAL RECORD

The University asks all its applicants whether they have any criminal convictions. If you have a criminal record, we can still consider you for a place but the University will ask for details of the offence. Depending on the nature of the conviction, the University may give further consideration to your admission before confirming any offer. You are not required to disclose spent convictions.

Do you have any criminal convictions? Yes ¨ No ¨

DECLARATION

Please sign and date your application to confirm that the information you have provided is accurate to the best of your knowledge.

Signed ...... Date ...... ………......

Please return your completed form to: Admissions Team (Part-Time Degrees), Centre for Lifelong Learning, University of Warwick, Coventry, CV4 7AL or by email to:

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