Undergraduate Application Form
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SECTION 1

Personal Details

TitleSurnameDate of Birth

(Mr/Mrs/Miss etc)Day Month Year

Forename (First Name)Previous Name(s), if changed Gender

Home AddressCorrespondence Address (if different)

Postcode: / Postcode:
Telephone: / Mobile:
E-Mail:
Country of Domicile: / Nationality:
Are you of member of Leeds Trinity University staff

SECTION 2

Taught Programme Sought

Qualification Aim Title of Programme

1st Choice of programme
2nd Choice of programme
3rd Choice of programme

e.g.BA/BSc etc

Mode of study Entry Level Proposed Date of Entry

Full or Part Time? Level 4/5/6? Month Year

SECTION 3

Qualifications to Date(most recent first)

Please enclose copies of all qualifications with this application. Failure to do so may delay your application.

School/College/
University / Dates
Start Finish / Qualification
e.g. A Level / Level of Study / Subject / Language of instruction (for course taken outside the UK) / Result
(grades or bands) / Date of Completion
What is your highest level of study?

SECTION 4

Is English your first/native language?

If English is not your first/native language you will be required to demonstrate competence through IELTS. Please forward evidence/certificate with this application if you have already completed IELTS.

If not yet completed, give test date below

IELTs score (certificates attached)Test Date

SECTION 5

Examinations to be taken(if none, write “none”):

Exam body
e.g. AQA / Exam date / Subject / Exam Level
e.g. A Level

SECTION 6

Employment History(most recent first)

Name and Address of Employer / Job Title / Dates
From To

SECTION 7

Personal Statement

Please indicate the reasons why you are applying for this course and why you are suitable for the course, your academic achievements and interests, any work experience and what you think you have learned from it, and your interests outside school work, etc

SECTION 8

Referees

Name at least one person from whom reference may be obtained. The referee should be qualified to comment on your educational background and potential for your chosen study. If work experience is used to support your application, then please submit a further reference. You should attach the reference letter(s) to this application form or it can be emailed (by the referee) direct to . References attached to this form should be on headed paper and signed by the referee, whose official contact details should be provided here, we may contact the referees to verify details:

Referee 1 - Name / Referee 2 (Optional)
Occupation / Occupation
Address / Address
Telephone / Telephone
E-Mail / E-Mail

SECTION 9

Disabilities/Special Requirements

At Leeds Trinity we provide a wide range of additional support to address individual needs. Please let us know if you have a disability such as visual impairment, mental health difficulty, a medical condition such as epilepsy, ME, or if you are hard of hearing, have dyslexia or you are a wheelchair user, for example.

We would be pleased to arrange an informal meeting with you to discuss any individual support requirements to enable you to participate in the course.

  • I have a disability or dyslexia and would like an informal meeting
  • I have a disability or dyslexia but do not require any additional support

If you would like to give any additional information to assist us in considering your additional support needs, please do so in the space below.

SECTION 10

Criminal Convictions Do you wish to declare any criminal convictions. If you are a serving prisoner, please supply the prison address below.

Yes No

For Non-European Economic Area (EEA) Applicants ONLY:

Passport No. / Country of Birth
Your immigration history (yes/no) – if yes, please provide details below - to comply with UKBA rules, you must answer each of the following questions even if the answer is “No” or “None”:
Have you ever been rejected/ refused or overstayed a UK visa or withdrawn by a UK institution? If yes, please provide the dates and reasons here:
Do you have a current UK visa? If yes, please provide us with your visa category, expiry date and the name and address of your current sponsor:
Have you ever studied in the UK previously? If yes, please provide details of the visa categories, the levels of programmes studied and the total length of study periods in the UK:

Declaration: I agree that if the information given on this form is later found to be false, Leeds Trinity may withdraw any offer or subsequent place on the programme of study. I understand that this information will be used for the purposes of admissions and will form part of a subsequent student record if I am accepted. I give my consent to the processing of my data and to use it for statistical reporting that will not identify me. I confirm that the information given on this form is true, complete and accurate.

Date of completion

Signature of Applicant:

*This can be typed if you don’t have an electronic signature Day Month Year

Please send your completed application form with references, copy of academic transcripts and (if applicable) English language certificates and any letters of sponsorship to.

Admission Decision(FOR OFFICE USE ONLY)

Accept Notes (i.e. record
outcome of
interview etc.)
Reject
Conditions (i.e. certs, reference etc.)

Start Date Qualification and
Programme Title
Day Month Year

Signature of Admissions Tutor Date