UNIVERSITY OF EDINBURGH

School of Health in Social Science

Continuing Professional Development Programme

(Applications deadline for semester one courses – 30thJune 2017)

Name:
Address:
Post code:
Home Tel:Mobile Tel:
Email Address:
Course applied for:
Gender:Female ☐Male☐ Date of Birth:
Do you wish to take this course for credit?Yes☐No☐
Have you ever applied to or studied with the University of Edinburgh?Yes☐No☐
If yes, please fill in your UUN (if known):
Country of Birth Domicile Nationality
Please indicate (by clicking on the relevant box) ethnic origin
White – Scottish ☐ Gypsy or Traveller ☐ Other White Background☐
Black or Black British – Caribbean ☐ Black or Black British – African ☐ Other Black Background ☐
Asian or Asian British – Indian ☐ Asian or Asian British – Pakistani ☐ Asian or Asian British – Bangladeshi ☐
Chinese ☐ Other Asian Background ☐
Mixed - White and Black Caribbean ☐ Mixed - White and Black African ☐ Mixed - White and Asian ☐ Other Mixed Background ☐ Arab ☐ Other Ethnic Background ☐
Do you wish to declare any disability, specific learning difficulty or medical condition?(Please note, your answer to this question is confidential and does not form any part of the admissions process; it is only used to help us provide you with the appropriate support you may require)
Yes☐No☐
If you wish to, please enter (in the box below) any specific support you may require

Personal statement
(Please outline your reasons for taking the course(s) (You may attach a separate sheet if necessary)
Entrance requirements
(Please state how you meet the entrance requirements for the course(s).
(We reserve the right to seek clarification and / or supporting evidence when deemed necessary).
Univ / College
and / or professional qualifications / Dates of attendance / Qualification obtained / Class of degree obtained / Taught in English
(Yes or No) / Principal Subject*

*If two principal subjects of approximately equal weight, please give both

Please indicate (by clicking on the relevant box) where you first heard about the course
Advert ☐ Blog by academic or student ☐ Online search engine ☐ Postgraduate course search sites ☐
Postgraduate Open day or Online information event Programme flyer ☐
Recruitment fair ☐ Recommendation from educational agent ☐ Recommendation from friend/colleague ☐ Recommendation from University of Edinburgh representative ☐ Social media network ☐
University of Edinburgh Prospectus University rankings ☐ Via MOOC/ free online course ☐ YouTube ☐ Other ☐
Do you have any criminal convictions?Yes☐No☐
If yes, please give details on a separate sheet and enclose with your application. Please note that your answer to this question is confidential. Spent convictions are unlikely to be considered relevant to the admissions decision.
Declaration
I declare that, to the best of my knowledge and belief, the information given on this application is true, complete and accurate and that no other information requested or material information has been omitted. I confirm that my personal and internship statements, enclosed, are my own work. I accept that, if I do not fully comply with these requirements, the University shall have the right to cancel my application or discontinue my registration on the programme and I shall have no claim against the University of Edinburgh in relation hitherto.
I understand that the University of Edinburgh holds information about everyone who applies to its courses and everyone who studies on them. The University discloses information about students to government agencies such as the Scottish Funding Council and the Higher Education Statistics Agency (HESA)> If my application is successful, the University will use the information to administer my studies, maintain its IT systems, monitor my performance and attendance, provide me with support, and for strategic planning. I understand that if an agent’s details have been given above, by submitting this application I am giving the University of Edinburgh permission to pass on any information about my application to that agent.
Signature:Date:
Data protection Statement
The University of Edinburgh is registered as a data user with the Office of the Data Protection Commissioner. All data kept within the University is treated as confidential. The University maintains student data in secure conditions and processes and discloses data in accordance with the terms of its Data protection notification. Personal data you supply to the University will be made available for official purposes to academic and administrative staff, but access to data is strictly confined to staff with relevant responsibilities. When you register as a student at the University of Edinburgh, you will be given further information about Data Protection and be asked to sign a statement of consent.