This document contains an application form for a university course. It requests personal details from the applicant such as name, address, date of birth, gender, nationality, and contact information. It also asks for details of the course being applied to such as title, mode of study, start date, and whether a scholarship or year abroad is desired. Further sections request information on the applicant's financial circumstances, disabilities, work experience, previous educational qualifications and establishments, English language proficiency, personal statement, referees, criminal convictions, and a signed declaration of the accuracy of the information provided.
This document contains an application form for a university course. It requests personal details from the applicant such as name, address, date of birth, gender, nationality, and contact information. It also asks for details of the course being applied to such as title, mode of study, start date, and whether a scholarship or year abroad is desired. Further sections request information on the applicant's financial circumstances, disabilities, work experience, previous educational qualifications and establishments, English language proficiency, personal statement, referees, criminal convictions, and a signed declaration of the accuracy of the information provided.
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For office use only
Student No: Application form 1 Personal details Title (PLEASE TICK APPROPRIATE BOX) Surname / Family name (BLOCK CAPITALS)
Dr Mr Mrs Miss Ms First name (s) Previous surname / Family name, if changed
Address Correspondence address
Postcode Postcode
Passport Number (for Overseas Applicants only) Will you require details on campus accommodation? (Please send photocopy of passport) Yes No
Country ( Drop Down Menu)
Daytime telephone number Evening telephone number Mobile telephone number
Email Address
day month year
Gender: Male (M) Female (F) Date of birth 2 Details of course to which you wish to apply Course title Mode of study Start date full-time / part-time month / year
Do you wish to register for a scholarship? Yes No
Name of scholarship
FOR INTERNATIONAL STUDENTS ONLY: Year Abroad Yes No Semester Abroad Yes No
Other Courses you wish to apply
For applicants for Nursing/ Midwifery programmes only:
Are you a Registered Nurse? Yes No
If yes, what is your NMC Pin Number:
Will you require a Student Visa whilst studying nursing/midwifery in the UK? Yes No
Are you eligible for an NHS bursary? Yes No
3 Financial and residential details Country of permanent residence Nationality
4 Disabilities and Special needs
Support required: Please enter appropriate code here: (see notes for guidance)
5 Work experience Give details of work experience, training and employment. Continue on a separate sheet if necessary. Job title Name of organisation Full time/ From To part time
6 Last two educational establishments at which you studied
Name and address of establishment From To Full time or part time
7 Qualifications (GCSE and above)
Recognised qualifications taken or results pending e.g. in professional examinations or overseas qualifications. For overseas qualifications please state UK equivalent, and include translations where possible. Please enclose copies of certificates and transcripts relating to the qualifications declared below. Qualification Subject Date Place of study Results CATS/ECTS (Grades or points (if bands) applicable)
8 English Language - Please enclose certified copies of certificates.
Is English your first language? Yes No
Was English the language of instruction at school/college/university? Yes No If no, what is your first language?
IF no give details of English language course taken / to be taken (eg IELTS,TOEFL)
Qualification Date taken and location Overall score Written score
9 Personal statement (please see Notes for Guidance) 10 Referees’ names and addresses (please see Notes for Guidance) Name Name
Address Address
Postcode Telephone number Postcode Telephone number
Finances:
Please explain how you will be able to pay for your Tuition or accommodation expense (Self financed, parents scholarship etc)
12 Disclosure of criminal convictions
Do you have any convictions, cautions, reprimands or final warnings?
YES NO Please circle appropriate response
13 Declaration I confirm that the information I have given on this form is true, complete and accurate and no information requested or other material information has been omitted. I have read the Notes of Guidance, in particular those relating to this section. I understand what they say and I agree to abide by the conditions set out there. I acknowledge that the information on this form will be used in accordance with the Caspian Khazri Edu ltd policy and will be used to form the basis of my student record. I give my consent to the processing of my data by the Caspian Khazri ltd. If I do not fully comply with these requirements the Caspian khazri shall have the right to cancel my application and I shall have no claim against the Caspian khazri in relation thereto.
