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| Required fields are marked with an asterisk (*) |
| About you |
| Your personal details |
| *Family name |
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| *Title |
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| *First name |
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| Middle name |
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| Preferred name |
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| Previous family name |
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| Effective date
Indicate here the dates between which you were known by a previous family name |
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| Previous first name |
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| Effective date
Indicate here the dates between which you were known by a previous first name |
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| *Gender |
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| *Date of birth |
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| Your contact details |
| Your home address |
| *Address line 1 |
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| Address line 2 |
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| Address line 3 |
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| City |
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| State/province |
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| Post/zip code |
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| *Country |
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| Address where we should send written correspondence (if not to home address) |
| Address line 1 |
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| Address line 2 |
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| Address line 3 |
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| City |
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| State/province |
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| Post/zip code |
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| Country |
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| Effective dates for correspondence address |
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| Contact numbers and email details |
| *Primary contact number |
| Type: |
| |
country |
( |
area
code |
) |
number | |
| Alternative contact number/s |
| Type: |
| |
country |
( |
area
code |
) |
number |
| Type: |
| |
country |
( |
area
code |
) |
number | |
| *Primary email address |
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| Alternative email address |
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| About your nationality and citizenship |
| *Country of birth |
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| *Country of nationality/citizenship e.g. as specified on your passport |
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| Please state effective date of current nationality |
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| If dual citizenship, please specify other country of nationality/citizenship |
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| *Country of legal permanent residence for last three years - International
students please note, this will be the country in which you normally
reside, not the country in which you are currently studying. |
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| If you have had legal permanent residence in more than one country during the last three years, please specify |
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| *What is your ethnic background? -
The University is required under statute to seek and return information
about the ethnic background of all its applicants for HESA (the British
Government's Higher Education Statistics Agency). The information
provided is used to monitor rates of participation in Higher Education
by particular groups of people, it does not form part of any assessment
of your application and is not made available to those assessing your
application. |
|
| Disability / special needs -
The University is committed to making reasonable adjustments to enable
disabled students or students with long term health conditions to
participate fully in student life. In order to provide study support,
relevant departments and colleges of the university may need to share
information about your needs. Information will be shared on a
need-to-know basis with people in the relevant departments and
colleges, such as departmental and academic administrators, lecturers
and tutors who will teach you, and relevant library and support staff.
The information provided is also used to monitor rates of participation
in Higher Education by particular groups of people, which is a
statutory requirement; it does not form part of any assessment of your
application. If you wish to discuss this section of the application
form, or anything to do with University provision for such needs,
please contact the Disability Office. |
| *Disability / special need - If
you do not regard yourself as having a disability or special need,
please select 'No known disability' from the list provided. If your
disability is not listed, please select disability not listed above and
specify details below. |
If not listed, please specify: |
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