NOT TO BE USED FOR TAUGHT MASTERS & OTHER POSTGRADUATE COURSES
FOR OFFICE USE ONLY
Reg. No. / STUDENTSHIP/BURSARY
Ref. No.RS/16/29
1. Personal details / 2. Further Details
Surname/Family Name / Age
Years Months
Date of Birth
Day Month Year
Disability/Special needs (refer to Notes for Guidance)
If you have a criminal conviction pleasetick
the box (please refer to Notes for Guidance )
Country of Permanent Residence ______
Country of Birth ______
Nationality ______
Passport Number (if available)______
If born outside the UK
Date first entry to live in the UK
Day Month Year
Residential Category (refer to Notes for Guidance)
First Name(s)
Home Address
Postcode (UK Only)
Home contact numbers
(inc. STD/Area Code) / Tel:
Mobile:
Personal E-mail:
Correspondence Address (if different) /Agent Address
Postcode (UK Only)
Home contact numbers
(inc. STD/Area Code) / Tel:
Mobile:
E-mail:
Previous surname/Family Name
3. Details of Research Degree for which you wish to apply
MA/MSc/LLM
(by Research) / PhD (via MPhil) / MPhil / MCh (Res) / MD (Res) / PhD
(by Published Work)
Name of proposed supervisor/contact (if known)
Please indicate how you heard of theprogramme(provide agent name if applicable)
4. Details of intended Fee Payment arrangements
I will be paying my own tuition fees(please tick) /
I will be in receipt of a grant or scholarship(please give details) /
I will be sponsored by my employer or other organisation(please provide evidence) /
I am a previous student of the University and will be applying for a fee reduction under the University Postgraduate Scheme. /
5. Physical or other disability or medical condition which might necessitate special arrangements or facilities:
6. Academic History
Please provide full details of educational background including institution name and dates attended, qualifications obtained, subjects and grades. Please attach photocopies of transcripts and certificates if available. (Please refer to Notes for Guidance). If you are awaiting the result of any examination recently taken write PENDING in the grade column. If you have previously studied in the UK, you MUST declare full details of this study on this form, including exact dates of study and also enclose copies of your previous UK visas when submitting the application form.
First Degree
Institution / Full Title of Award / From (year) / To ( year) / Grade
Postgraduate Qualifications
Institution / Full Title of Award / From (year) / To ( year) / Grade
Professional Qualifications (please continue on a separate sheet if required)
Institution / Full Title of Award / From (year) / To ( year) / Grade
English Language Qualifications
If your first language is not English, please state which qualifications (eg.IELTS, TOEFL) in English Language you hold or are currently studying, the score or grade if known and date taken. Please attach a photocopy of transcript and certificate if available. (Please refer to Notes for Guidance)
Type of Qualification / Month / Year / Grade
7. Employment (please indicate your employment experience including any details relevant to the research for which you are applying)
Employer / Nature of Work / Full-time/Part-time / Dates
Present Employer (if any)
Name
Address
Tel. No.
Previous Employers (continue on a separate sheet if necessary)
8. Project Outline
Please give an outline of your proposed Research Project (suggested equivalent A4 length) detailing the aims, methodologies and research activities involved in the project.
10. Academic References
Please supply the name and address of the academic referees to whom you will send the reference form
Your referees should be able to comment on your academic ability, character and your suitability for research work.
1st Referee / 2nd Referee
Name / Name
Address / Address
Occupation / Occupation
Tel. No. / Tel. No.
NB: The reference may accompany this application or be sent to the University separately. References must be from an academic who has previously taught you.
It is your responsibility to contact your referees directly and ask them to forward to the address on the reference form or email to
11. Previous applications
Give details (with dates) of any previous application, or of correspondence relating to admission to study for a higher degree at this University.
12. Declaration
Declaration:I confirm that the information given on this form is true, complete and accurate and no information requested or other significant material information has been omitted. I have read the Notes for Guidance for Completion of the Application Form.
Applicant's Signature: ......
Date: ...... / Please return to:
Senior Research Administrator (Admissions)
Research Student Registry
University of Central Lancashire
Preston
PR1 2HE
Lancashire
UK
Email :
I do not want to be contacted by the University with details of its courses or its other products or services
ACADEMIC REFERENCE
Statement by RefereeRS/16/29
Applicants Full Name
Name of Referee
MA/MSc/LLM (by Research) / MPhil / MD (Res) / PhD (*delete as applicable)
Post / Occupation / Relationship to applicant
Address
Tel. No (including STD):
Mobile:
Email:
Can this reference be discussed with the applicant / Yes / No
Can this reference be revealed to the applicant / Yes / No
Notes for the guidance of referees
In order to select those students who will benefit from their chosen programme of study, the University requires a supporting statement from a referee.
Your reference about the applicant should, if possible, cover the following:
- Suitability for a research degree
- Intellectual qualities including previous academic performance and any relevant subject experience through work or study
- Personal characteristics including evidence of ability to sustain study at the level of their chosen research
- Career aspirations
- How long have you known the applicant
Signed ......
Date ......
(Please affix official stamp where appropriate at end of the statement) / Please Return to:
Senior Research Administrator (Admissions)
Research Student Registry
University of Central Lancashire
Preston
PR1 2HE
Lancashire
UK
Email :
ACADEMIC REFERENCE
Statement by RefereeRS/16/29
Applicants Full Name
Name of Referee
MA/MSc/LLM (by Research) / MPhil / MD (Res) / PhD (*delete as applicable)
Post / Occupation / Relationship to applicant
Address
Tel. No (including STD)
Mobile:
Email:
Can this reference be discussed with the applicant / Yes / No
Can this reference be revealed to the applicant / Yes / No
Notes for the guidance of referees
In order to select those students who will benefit from their chosen programme of study, the University requires a supporting statement from a referee.
Your reference about the applicant should, if possible, cover the following:
- Suitability for a research degree
- Intellectual qualities including previous academic performance and any relevant subject experience through work or study
- Personal characteristics including evidence of ability to sustain study at the level of their chosen research
- Career aspirations
- How long have you known the applicant
Signed ......
Date ......
(Please affix official stamp where appropriate at end of the statement) / Please Return to:
Senior Research Administrator (Admissions)
Research Student Registry
University of Central Lancashire
Preston
PR1 2HE
Lancashire
UK
Email :
Postgraduate Research Programme Application:
Planning Statistics
Ethnic origin (this information will not be made available to Admissions Tutors for selection purposes)
Please choose from the ethnic origin terms printed here the one which you feel most nearly describes your ethnic origin and write its code in the boxes
If you have used the code (29), (39), (49), or (80), please describe your ethnic origin using your own words in the space provided:
10 White - British / 33 Asian or Asian British - Bangladesh / 49 Other Mixed background
21 Black or Black British - Caribbean / 34 Chinese / 80 Other Ethnic background
22 Black or Black British - African / 39 Other Asian background / 90 Not known
29 Other Black Background / 41 Mixed – White and Black Caribbean / 98 Information refused
31 Asian or Asian British - Indian / 42 Mixed – White and Black African
32 Asian or Asian British - Pakistani / 43 Mixed – White and Asian
As appropriate, we reserve the right to check your application for entry to the UK with the relevant British Government Office.
All the personal information provided above, together with any further information the University obtains is used to process your application. It may also be used by the University to undertake research to plan or improve our services. In addition the University may advise you of other study opportunities and services provided by it. If you do not wish to receive this information please write to: Advancement, Chandler Building, UCLan.