Only for Applications Not Handled by a Clearing House (UCAS/GTTR/NMAS)

Application Form

Only for applications not handled by a clearing house (UCAS/GTTR/NMAS)

Please complete in BLOCK CAPITALS.

For Office Use Only: / App. No. / Fee Status:
Personal Details
Title: / Male (M) Female (F): / Date of Birth:
Surname / Family Name:
First / Given Name: / Coach Code:
(LTA use only)
Home Address: / Postal Address (if not home):
Post Code: / Post Code:
Telephone (Including STD / Are Code): / Telephone (Including STD / Are Code):
Mobile Telephone: / Other Telephone
Email Address:
Further Details
Area of Permanent Residence:
County of Birth:
Nationality: / Date of First Entry to Live in UK:
Courses Applied For
Course Title / Mode of Study / Month & Year of Entry / Stage
Criminal Convictions
If you have any relevant criminal convictions, enter X in the box:
Disability Special Needs
If you have a disability or special needs, enter and X in the box:
School / College / University Education (from age 11 starting with most recent)
From: / To: / Institution: / PT/FT/SW:
Qualifications Completed (exams or assessment, etc)
Date: / Subject: / Level: e.g. GCSE, A Level, BTEC, Other / Grade / Result: / Date: / Subject: / Level: e.g. GCSE, A Level, BTEC, Other / Grade / Result:
Qualifications Not Yet Completed
Subject: / Level of Award: / Expected Completion Date:
English Language Proficiency (International Students Only)
Was English the language of instruction in your previous institution?
Number of years you have studied English?
I hold the following qualifications:
IETLS: / Score (If Known): / Date of Test: / DD/MM/YYYY / Location:
TOEFL: / Score (If Known): / Date of Test: / DD/MM/YYYY / Location:
Other: / Score (If Known): / Date of Test: / DD/MM/YYYY / Location:
If Test yet to be completed, please state date to be taken / DD/MM/YYYY / Location
IETLS: / TOEFL: / Other:
Additional Training
Subject: / Organising Institution / Completion Date:
Employment History
Name of employer: / Nature of Work: / From: / To: / PT / FT:
MM/YYYY / MM/YYYY
MM/YYYY / MM/YYYY
MM/YYYY / MM/YYYY
Personal Statement (Minimum 250 words in English)
Names and Addresses of two referees
Name in Full: / Name in Full:
Home Address: / Postal Address (if not home):
Post Code: / Post Code:
Phone: / Phone:
Email Address: / Email Address:
Declaration
I confirm that the information given in this form is correct and complete. I accept that the University has the right to cancel my application if it is found that I have provided false or inaccurate information. I have read the instructions, in particular those regarding this section. I understand what they say and I agree to abide by the conditions
Applicants Signature: / Date: