6 Examinations

Pleaselistresults,includingthosepending,andattachphotocopiesofyourcertificatesortranscripts.

LevelegGCSE/Degree Subject Date(mm/yyyy) Institution Result

4 Work experience

5 Last two educational establishments attended

Givedetailsofworkexperience,trainingandemployment.Continueonaseparatesheetifnecessary.

Givenamesandaddressesofthelasttwoeducationalestablishmentswhichyouattended.

Jobtitle NameofOrganisation Full-orpart-time From(mm/yy) To(mm/yy)

Establishment Full-orpart-time From(mm/yy) To(mm/yy)

www.beds.ac.uk November2010

HaveyoupreviouslystudiedattheUniversityofBedfordshire(orLuton/DMUBedford)?YES/NO

Ifyes,pleaseprovidedetailsofthecourse(title)

Formerstudentreferencenumber

IfyouhaveQualifiedTeacherStatuspleasegiveusyourTeacherreferencenumber

www.beds.ac.uk November2010

7 Additional needs

Pleaseindicateifyouhaveadisability:

Nodisabilityn AutisticSpectrumn VisualImpairmentn HearingImpairmentn Long-termHealthn

MentalHealthn Dyslexian WheelchairUsern Otherdisabilitynotlistedn Multipledisabilityn

Pleasegivefurtherdetailsofanysupportneedswhichmightnecessitatespecialarrangementsorfacilities:

8 Names of referees

9 Further information

Pleasegivethenamesandcontactdetailsoftwopeoplewhocancommentonyoursuitabilityforthiscourse,whichcouldincludeateacher,anacademictutor,currentemployer,workexperienceco-ordinator.

Pleaseusethissectiontotellusaboutyourselfandyourreasonsforwantingtostudythiscourse.Youmayprefertoattachaseparatestatement.

Name Name

Organisation Organisation

Telephone Telephone

Fax Fax

Email Email

Relationshiptoyou Relationshiptoyou

Notes for guidance

IMPORTANT NOTETheUniversityofBedfordshirewilltakeallreasonablestepstoprovidetheeducationalservicesetoutinitsprospectuses.ShouldindustrialactionorothercircumstancesbeyondthecontroloftheUniversityofBedfordshireinterferewithitsabilitytoprovidesuchaservice,theUniversityofBedfordshirewilltakereasonablestepstominimisetheresultantdisruption.TheUniversityofBedfordshiredoesnotundertakeanyabsoluteobligationwhatsoevertoprovideaneducationalserviceinthemannerspecifiedinitsprospectusesorinanyotherdocument,nordoesitundertakeanyotherobligationinrespectoftheprovisionofaneducationalservicewhichismoreonerousthantheobligationssetouttherein.

ShouldyoubecomeastudentoftheUniversityofBedfordshire,thisnoticeshallbeatermofanycontractbetweenyourselfandtheUniversity.AnyofferofaplacemadetoyoubytheUniversityofBedfordshireismadeonthebasisthatinacceptingsuchanofferyousignifyyourconsenttotheincorporationofthisnoticeasatermofanysuchcontract.

General

Beforecompletingtheform,pleaseensurethatyoureadthesenotescarefully.YoushouldalsoreadthecurrentUniversityofBedfordshireliteraturerelatingtothecourse(s)inwhichyouareinterested.TheUniversity’sregulationsaretobefoundatatwww.beds.ac.uk/aboutus/quality/regulations.

StudentswithExperience

TheUniversityofBedfordshirewelcomesapplicationsfromstudentswithexperience,includingthosewhodonothaveconventionalqualificationsforadmissiontohighereducationintheUK.Fullaccountistakenofrelevantexperienceandothereducationalachievements.

TheDataProtectionAct1998

Theinformationwhichyougiveonyourformwillbeusedforthefollowingpurposes:

•TodetermineyoureligibilityforentrytotheUniversityofBedfordshire.

•ToenabletheUniversityofBedfordshiretocompilestatisticalreports.

•ToenabletheUniversityofBedfordshiretoinitiateyourstudentrecord.

•Toshareinformationwithgovernmentdepartments(egimmigrationoffice),localauthoritiesandotherbodiestopreventpossiblefraudandtoenablethemtocarryouttheirfunctions.

Section1Personaldetails

CompletethissectioninBLOCKCAPITALS.

Section2Detailsofthecourse(s)youwishtoattend

Ifyouwishtoindicateanorderofpreferenceforyourcoursechoicesyoumaydoso.Ifyoudonotindicateanorderofpreferencethenitwillbeassumedthatyouhavenone.

Section3Feestatus

Pleasestateyourcountryofpermanentresidenceandgivedetailsofwhoyouexpecttopayyourfeesfortheproposedcourse.

Section6Examinations

Entertheexactsubjectnameusedbytheexaminingbodyandthenameoftheexaminingbodyinfull.IfyouhavequalificationsobtainedoutsidetheUK,youshouldgivedetailsofallexaminationstakenaspreparationforentrytohighereducation(egSchoolandHigherSchoolCertificate,Apolytirion,Baccalaureat).ApplicantswithqualificationsobtainedinalanguageotherthanEnglishmustattachacertifiedEnglishtranscripttotheform.

Section7Additionalneeds

Describeyourconditionand,whereitisnotobvious,indicatewhetheryouhavespecialneeds.

10 Declaration and submission

Weexpectyoutosubmitacompleteandcomprehensiveapplicationatthepointoffirstsubmission.Thiswillenableustoproperlyassessyoursuitabilityforthecourse.Itisthereforeinyourbestintereststoprovideuswithaccurateinformationandtoensurethatyouarefullyinformedaboutthecourseyouareapplyingforandthecommitmentsyouwouldbemakingifyoubecomeastudenthere,andtoensurethatyouhaveattachedcopiesofyourqualificationsandtwosuitablereferences.Bysigningyourapplicationyouareconfirmingthattheinformationprovidedonthisformiscompleteandcorrect.

Iconfirmthat,tothebestofmyknowledge,theinformationgiveninthisformiscorrectandcomplete.

Applicant’ssignature Date

Please return the completed form to:Admissions Admissions University of Bedfordshire University of Bedfordshire Park Square Polhill Avenue Luton Bedford Fax: +44 (0)1582 489323Bedfordshire Bedfordshire Email: admission@beds.ac.ukLU1 3JU MK41 9EAEngland England www.beds.ac.uk