FOR OFFICE USE ONLY Reg. No.

International Application Form for Summer Courses Taught Programmes

1. Personal details (Please refer to Notes for Guidance) 2. Further Details (Please refer to Notes for Guidance)

Surname/Family NameAge

Years Months

Male (M) Female (F)

Date of birth

DD / MM / YY

Disability/special needs (refer to Notes for Guidance)

Country of permanent residence____________________________

Country of birth _______________________________________

Nationality ___________________________________________

Passport No. (if available) _______________________________

First Name(s)

Permanent Address

Postcode

Home contact numbers(inc. STD/Area Code)

Tel:

Fax:

Email:

Correspondence address (if different)

Postcode

Contact numbers(inc. STD/Area Code)

Tel:

Fax:

Email:

3. Details of course for which you wish to apply (Please refer to Notes for Guidance)

Summer course applied for Foundation Design Workshop

Month and year in which you wish to start:

Full course title: 1st choice

2nd choice

3rd choice

Please indicate how you heard of this course (provide name of Agent if applicable)

4. Details of intended Fee Payment arrangements (Please refer to Notes for Guidance)

i. I will be paying my own tuition fees - Please tick - Yes No

ii. I will be in receipt of a grant or scholarship (please give details) Yes No

iii. I will be sponsored by my employer or other organisation Yes No

(please give details to enable us to contact your sponsors & arrange any necessary administration)

5. Physical or other disability or medical condition which might necessitate special arrangements or facilities:

6. Qualifications Please provide full details of educational background including institution name and dates attended, qualifications ob-tained, subjects and grades. Please attach photocopies of transcripts or certificates if available (please refer to Notes for Guidance)

Institution Name

Dates attended From (month & year) To (month & year)

Qualifications

Institution Name

Dates attended From (month & year) To (month & year)

Qualifications

Institution Name

Dates attended From (month & year) To (month & year)

Qualifications

7. If your first language is not English, please state which qualifications (eg, GCSE, IELTS, TOEFL) in English Language you hold or are currently studying, the score or grade if known and date taken. Please attached a photocopy of transcript or certificate if available.

Qualification: Score or Grade: Date taken:

Qualification: Score or Grade: Date taken:

8. Declaration

I confirm that the information given on this form is true, complete and accurate and no information requested or other significant information has been omitted. I have read the Notes for Guidance for Completion of the Application Form. I confirm that I have completed and signed this form myself.

Applicants Signature: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date: . . . . . . . . . . . . . . . . . . . .