Application for Studying Abroad at Northumbria For office use only App no. 1 Personal Details Title Male (M)/Female (F) Date of Birth D D M M Y Y Family Name Given Name Home address Postcode Telephone Mobile telephone no Postal address Postcode Telephone Mobile telephone no Email address When would you like to study Abroad? September January Both PLEASE INCLUDE A PHOTOCOPY OF THE PERSONAL DETAILS SECTION OF YOUR PASSPORT 2 Further Details Country of permanent residence Country of Birth Nationality 3 Qualifications and Current Studies From To Institution Subject Full/Part time PLEASE PROVIDE A TRANSCRIPT FROM YOUR CURRENT INSTITUTION AS EVIDENCE OF YOUR GRADES
4 Parental/Guardians Contact Details Name Relationship to you Home address Emergency contact number Email address 5 English language proficiency (for speakers of other languages) Please include proof of qualifications with your application Was English the language of instruction in your previous institution Yes No Partly Number of years you have studied in English I hold the following qualifications: IELTS Score (if known) Date of test D D M M Y Y Awarding Institution TOEFL Score (if known) Date of test Awarding Institution Other qualifications (please specify) Score (if known) Date of test If test yet to be completed, please state date and location IELTS TOEFL Other Location
6 Module selection The maximum number of credits we allow a student to take is 60 per semester. Please note that this includes EL0420 Colloquium on British Culture, which is a mandatory 10 credit module for all students. Information on modules offered at Northumbria can be accessed via the University website: http://www.northumbria.ac.uk/brochure/international/studyandworkabroad/comingtonorthumbria/constructingprogramme You should submit your selection in order of preference and include additional modules should your first choice of modules not be available. Please could you give 10 module choices. Module Code Module Name No. of Credits 7 Disability/Special Needs You will need to please refer to the How to Apply Guidelines pdf for further details on how to complete this section If you have a disability or special needs please enter the relevant code in the box Criminal convictions If you have any relevant criminal conviction, enter an X in the box 8 Personal Statement You must attach a two paged, typed, double spaced statement, in English, which includes the following information - Your reasons for wanting to spend a semester abroad - Your reasons for selecting Northumbria - Why you have chosen the modules stated - Past travel or study abroad experiences - Any information you feel to be relevant to your application The whole form, including references, should then be returned to: The Study Abroad Administrator International Office Room 0006 21/22 Ellison Place University of Northumbria Newcastle Upon Tyne NE1 8ST United Kingdom
9 References - First reference Students name: To the Student - Please have your Personal Tutor and one other Member of your School/Faculty fill out your reference statements included with this application. To the Referee - The above named student has applied to the Study Abroad Programme. Life away from home can be a demanding experience, requiring adaptability and emotional stability. Your help in appraising the applicant's strengths and limitations in this regard would be greatly appreciated 1 How long and in what capacity have you known the applicant? 2 In comparison with other students whom you have known at comparable stages, how would you rate the applicant in the following areas? If you are unable to evaluate an area, please leave it blank. Academic Performance Excellent Good Average Poor Independance Initiative Enthusiasm Adaptability Maturity 3 What is your appraisal of the applicant's suitability for study away from home? Please state briefly the reasons for your answer. Referee's name and position Address Signature and date
10 References - Second reference Students name: To the Student - Please have your Personal Tutor and one other Member of your School/Faculty fill out your reference statements included with this application. To the Referee - The above named student has applied to the Study Abroad Programme. Life away from home can be a demanding experience, requiring adaptability and emotional stability. Your help in appraising the applicant's strengths and limitations in this regard would be greatly appreciated 1 How long and in what capacity have you known the applicant? 2 In comparison with other students whom you have known at comparable stages, how would you rate the applicant in the following areas? If you are unable to evaluate an area, please leave it blank. Academic Performance Excellent Good Average Poor Independance Initiative Enthusiasm Adaptability Maturity 3 What is your appraisal of the applicant's suitability for study away from home? Please state briefly the reasons for your answer. Referee's name and position Address Signature and date
11 Declaration If you are completing this form electronically, please read the declaration below and tick this box I confirm that I have completed this application form myself and that the information given in this form is correct and complete. I accept that the University has the right to cancel my application and enrolment if it is found that I have provided false or inaccurate information. I have read the How to Apply Guidelines, in particular those regarding this section. I understand what they say and agree to abide by the conditions set out there, which I accept as a condition of this application. I accept that the University will inform the UK immigration authorities of my enrolment status, for example if I do not enrol at the University or if I do not enter my programme of if I discontinue my studies at any time. I also agree that details of my admission and enrolment and any Confirmation of Acceptance for Studies will be passed to the representative, agent or institution to which I submitted my application. If you are completing this form by hand please sign below:... Date D D M M Y Y