Title:
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Forenames:
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Surname or Family Name:
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Date of Birth:
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Gender:
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Country of Birth:
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Nationality:
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Country of permanent residence:
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Permanent address:
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Address for correspondence (if different):
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Programme of study
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Method of Study:
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Commencement date:
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Completion date:
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Academic/professional qualifications:
Give details of all undergraduate and postgraduate study and any other
academic or professional qualifications relevant to your application,
including any qualifications for which you are studying or awaiting the
results. State title and class of degree or other qualification, the
University ot insitution by which it was awarded and the date of the award.
Note: Copies of certificates awarded for the above qualifications and full transcripts must be provided with this application.
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English language qualifications:
Please provide evidence of any English language qualifications which
you have obtained. If you have no qualification please indicate
whether or not your degree studies have been conducted and examined in
English.
Degree studies conducted and examined in English (please provide evidence) :
Other English Language Qualifications:
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Experience:
Give details of all periods of employment or voluntary work lasting more than
three months. State dates, position, employer.
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Special Needs:
Please outline any special needs support that you may require in order to fully
undertake your studies as a consequence of any disability or medical condition.
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Assessment of fees:
In order to assist the University to assess your status for the purpose
of fees, please indicate the exact dates of your residence in the E.U
(if any) and the purpose for which you were so resident. Please provide
copies of any relevant documents.
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Financial Support:
What will be your financial support? Will you be...
(a) supporting yourself?
(b) supported by your employer?
(c) supported by any other sponsor?
If (b) or (c) please give the name and address of person or body responsible for payment of your fees:
Name:
Address:
Have you applied for this support? Have you obtained this support?
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Referees:
Give the names, positions and addresses of the two persons who have provided
sealed references in support of your application who have knowledge of your ability to undertake the proposed study.
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Publicity:
Please indicate below the two most important sources of information used in
making your decision to apply to Loughborough University.
1.
2.
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Other applications
Please indicate any other universities and courses to which you have applied:
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Equal Opportunities Policy
The University has an Equal Opportunities policy. We want to ensure
that all applicants are treated equally regardless of their gender,
race, colour, ethnic origin or disability.
To do this we need to know about the people who apply to us and would
be grateful if you would complete the the following questions. Your
answers will be used solely to evaluate the effective operation of the
Equal Opportunities Policy. Your answers will therefore not affect your
application in any way.
Please select which group best describes your ethnic origin or descent
Please indicate below if you have any of the following disabilities:
Dyslexia
Blind/partially sighted
Deaf/have a hearing impairment
Wheelchair user/have mobility difficulties
Personal care support
Mental health difficulties
Unseen disability e.g. diabetes, epilepsy, asthma
Multiple disabilities
A disability not listed above
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Loughborough Universitiy requires the information on this form
for the purposes of processing your application for postgraduate
study. All personal information will be treated strictly in terms of
the Data Protection Act 1998. Students registering with the
University will be asked to read and sign a data protection
statement.
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