MA Jewish Education application form

This programme is quality assured by Middlesex University and you will receive a Middlesex award on successful completion.

Part A

Please ensure this section is completed fully and accurately.

A1. Your personal details(as they appear on official documents)

Please provide details of your ethnic group and any disability so that LSJS can monitor equal opportunities and ensure appropriateprovision.

Title (tick one) / Dr / Mr / Mrs / Miss / Ms / Rabbi / Other
Forenames
(As stated on your Birth Certificate) / Email
Surname / Former surname
(if different)
Address / Post Code:
Correspondence Address if different from permanent / Post Code:
Home Tel: / Mobile:
D / D / M / M / Y / Y / Y / Y
Date of birth
Gender / Male / Female
Do you consider yourself to have a disability under the terms of the DDA? / YES / NO
Are you registered as Disabled? / YES / NO
What is the nature of your Disability? Do you have any additional support needs?
Ethnic Origin (Please tick one):
White British / Black or Black British, Caribbean / Asian or Asian British, Indian
White Irish / Black or Black British, African / Asian or Asian British, Pakistani
White Other / Other Black background / Asian or Asian British, Bangladeshi
Other Asian background / Chinese or other ethnic background – Chinese / Mixed, White & Black Caribbean
Mixed, White and Black African / Other ethnic background / Other mixed background
Jewish Sephardi / Jewish Ashkenazi / Information refused
Not known

Are you currently working in a school? (Please tick)

Yes / No / If yes, in what capacity?
Primary
Secondary
Residential Information
Please provide information relating to your nationality and residence. Attach copies of any pertinent Home
Office documentation. Further information may be requested.
Country of permanent residence:
If UK, please give County/Borough:
Country of birth:
Nationality (as on passport):
National Insurance Number:
Fee Payment
Please provide details of how you intend to pay your tuition fees. Applicants may be asked to supply details of their financial position and their provision for the payment of fees.
Who will pay your tuition fees? Self-Funded: Yes 
Employer (please specify):
Other (please specify):

A2. Your education and qualifications

Please note that we must see ORIGINAL documents as we are responsible for confirming that candidates meet the entry requirements.

A2.1Higher Education

  • If you are unsure whether a qualification is equivalent to a degree or for qualifications obtained overseas contact for advice on having certificates recognised and evaluated.
  • If relevant please enter your undergraduate details below.
  • Any additional qualifications should be entered in the box at the end of this section.
  • English Language proficiency is a requirement of the course. If applicable please enter relevant English Language qualifications in Section A2.2.

Institution of study
Degree-awarding body (if different)
Country of study
Title of course
Main subject
Subsidiary subject if applicable / Percentage of course: / %
Qualification obtained
Degree class / First class honours 1 [ ] / Upper second 2.1 [ ] / Lower second 2.2 [ ]
Third 3 [ ] / Pass [ ]
Dates of study / from / M / M / Y / Y / to / M / M / Y / Y / Date of Award / M / M / Y / Y

For qualifications other than a UK degree, give evidence below that the qualification is equivalent. A letter from NARIC should also be attached.

Yeshiva /Seminary Attended(if applicable)
Name: / from / M / M / Y / Y / to / M / M / Y / Y
A2.2Other Relevant Qualifications including GCSE and A Levels or equivalent
Title / Main Subject(s) / Awarding body / Completion date / Title / Main Subject(s) / Awarding body / Completion date
Please continue on a separate page if needed.
A.2.3 Other Languages:Please indicate your level of proficiency in Ivrit and Biblical Hebrew as well as any other modern foreign languages
Name of language / First Language? / Education received / Qualifications obtained / Reading / Writing / Speaking / Translation
Ivrit
Biblical Hebrew

Part B

Your experience and academic/teaching/leadership potential

B1. Current employment or voluntary work

Please give details of current employment, in the UK or elsewhere.

Organisation
Country / Post held
Dates of service / From / To
Main responsibilities

B2. Previous employment or voluntary work

Please give details of previous employment, in the UK or elsewhere.

Organisation
Country / Post held
Dates of service / From / To
Main responsibilities
Organisation
Country / Post held
Dates of service / From / To
Main responsibilities
Organisation
Country / Post held
Dates of service / From / To
Main responsibilities

B3 Other relevant experience

Please give details of any other relevant work experience (paid or voluntary) to show your potential to do this postgraduate degree course. Examples of work to include:
  • non-teaching work in educational settings (teaching assistant, learning support assistant, instructor etc.) with adults, young people or children;
  • work in non-educational settings (youth or community work etc.), with adults, young people or children;
  • occupations or activities that have required the use of the appropriate subject knowledge;
  • Occupations or activities (training etc.) that have contributed to the educational or personal development of adults, young people or children.
  • Occupations or activities (training etc.) that have enabled you to develop leadership skills

OTHER RELEVANT EXPERIENCE(Please attach additional pages)
PERSONAL STATEMENT (Please attach additional pages)
  1. Please write a personal statement in support of your application for anMA Jewish Education degree. Attach this to the application (900 words maximum):
In your statement you may wish to reflect upon some of the following:
  • your academic potential for this postgraduate degree course
  • what appropriate personal and intellectual qualities you possess
  • your educational experiences to date, indicating why you feel you are suitable for the MA Jewish Education
  • your subject knowledge relevant to your proposed higher degree
  • your future goals and career aspirations.

Declaration Of Criminal Record

In an effort to help the University reduce the risk of harm or injury to their staff and students caused by the criminal behaviour of

Declaration Of Criminal Record
In an effort to help the LSJS reduce the risk of harm or injury to their staff and students caused by the criminal behaviour of other students we must know about any relevant criminal convictions an applicant has.
In this matter relevant criminal convictions are deemed only to be those convictions for offences against a person, whether of a violent or sexual nature and convictions for offences involving unlawfully supplying controlled drugs or substances where the conviction concerns commercial drug dealing or trafficking. Convictions that are spent (as defined by the Rehabilitation of Offenders
Act 1974) are not considered to be relevant and you should not reveal them.
By virtue of the Rehabilitation of Offenders Act 1974 (Exemptions) Order 1975 and the Child Act 1989, applicants are not entitled to withhold information about convictions which for other purposes are ‘spent’ under the provisions of the Act. If you are offered a place on one of these courses and before you commence your studies, you will need an ‘Enhanced Disclosure Document’ from the
Criminal Records Bureau or the Scottish Criminal Record Office Disclosure Service.
Have you been through the Criminal Records Bureau Enhanced Disclosure process (DBS) in relation to your current employment? YES [ ] NO [ ]
If Yes, please state the date and reference number:
Do you have a relevant unspent criminal conviction?
YES [ ] NO [ ]
Applicants who have a previous conviction will not be automatically excluded from the application process. However, if you have ticked Yes, please disclose details of your offence and conviction, including dates and courts convicted at. This information should be submitted along with your application form in a separate sealed envelope, clearly marked confidential with your name and date of birth on it. Any information disclosed will be handled and disposed of securely by LSJS in compliance with the Criminal Records Bureau Code of Practice, the Data Protection Act and other relevant legislation.
If you are convicted of a relevant criminal offence after your application has been submitted, you must notify us. The University may request further disclosure from you and your offence may affect your application.
REFERENCES
Name of principal referee
(Should be able to comment on your academic potential) / Name of second referee
Post/Occupation/Relationship: / Post/Occupation/Relationship:
Address: / Address:
Postcode: / Postcode:
Tel: / Fax: / Tel: / Fax:
Email: / Email:

Please send the completed form to Jane Clist at

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