/ LJMU RD12Rev 2016

APPLICATION FOR THE AWARD OF A HIGHER DOCTORATE

This form must be completed electronically and signed by the applicant. Please insert answers in the grey boxes or click on choose an item to select from the drop down lists available.

Please note that the Doctoral Academy is unable to accept handwritten, incomplete or unsigned applications.

HIGHER DOCTORATE TO WHICH THIS APPLICATION RELATES:

Choose an item.

PARTICULARS OF APPLICANT:

Full Name: Date of Birth (dd/mm/yy):

Address for correspondence (including email address):

Academic Awards and Qualifications (Brief details including dates and awarding bodies):

Professional and/or Academic Experience (with dates):

Present Position:

Previous Experience:

Honours, Awards (other than academic awards) and other distinctions:

CONCISE DESCRIPTION OF THE SPECIFIC FIELD OR FIELDS IN WHICH THE APPLICATION LIES:

LIST OF ALL WORK SUBMITTED IN SUPPORT OF THE APPLICATION WITH TITLES, DATES, AUTHORS, PAGE REFERENCES ETC. (this may be continued on a separate sheet if necessary):

STATEMENT BY THE APPLICANT:

I wish to apply for the degree stated above and confirm that all the information given in the above application is correct and that work referred to as my own contribution is truly so described.

I confirm that I either hold a degree of the CNAA or LJMU or fulfil one of the following two conditions:

  • I am a member of the University’s staff ☐
  • I am an alumnus of Liverpool John Moores University or the former Liverpool Polytechnic ☐

I have stated which part of my submission, if any, has been submitted for another academic award.

This application is made in accordance with the University’s Regulations for the Award of Higher Doctorates and is accompanied by all the material required by those Regulations.

Signature: Date:

Please return the completed and signed form either by email as a pdf, by post or in person to: GRADUATE SCHOOL, Kingsway House, Hatton Garden, Liverpool, L3 2AJ