2017 Entry PART-TIME DEGREES APPLICATION FORM PLEASE COMPLETE IN BLOCK CAPITALS AND BLACK INK Title: Date of Birth: Last Name: Age on 1 Sept 2017: First Name(s): Where did you hear about the Programme? Previous Surname (if applicable): Address: Nationality: How long have you lived in the UK? Telephone: Email: Please indicate the degree course in which you are interested. If you are interested in more than one degree please indicate them in order of priority. Degree Classical Civilisation/Ancient History & Classical Archaeology English and Cultural Studies French Studies Health and Social Policy History Social Studies Priority EXEMPTIONS/ADVANCED STANDING We are happy to consider requests for exemptions from modules on the basis of academic or professional qualifications. If you wish to be considered please complete the APL Form located at: http://www2.warwick.ac.uk/services/aro/dar/quality/categories/courseapproval/apel/ Page 1 of 5
PREVIOUS EDUCATION Please provide details of all schools, colleges and universities you have attended (from secondary education) Name of school/college/university: Dates: QUALIFICATIONS Please list your examinations, professional qualifications and any training taken or currently being followed (copies of certificates must be enclosed in order for your application to be processed) Exam Type (eg GCSE, GNVQ, City and Guilds) Subject Date Result/Grade PLEASE LIST ANY QUALIFICATIONS FOR WHICH YOU ARE CURRENTLY STUDYING Course/qualification/establishment Subject Expected completion date PREVIOUS EMPLOYMENT EXPERIENCE, IN DATE ORDER, UP TO THE PRESENT Dates Name of Employer Position REFERENCES The University requires either one academic reference (from a tutor at college or someone else who has taught you in a formal setting) or two character references from people who know you well. You should not ask a member of your family, but an employer, colleague, or other professional person would be suitable. Please give each of your referees a copy of the reference notes. Ask your referees to put their reference in a sealed envelope, sign over the seal, and give the reference to you. Please return your completed application form along with reference(s) to the University of Warwick with your completed application form. Page 2 of 5
PERSONAL STATEMENT Please write about 500 words explaining why you would like to study for a degree. You should cover the following themes: Why you have chosen this degree How studying for a degree will relate to your interests and/or work Any activities that you are currently involved in (e.g. work, voluntary or family responsibilities) How your work or other experiences have prepared you for further study Which topics are of particular interest and why Any reading or activity you have already undertaken in your proposed area of study Your interest in books, films, theatre, music, sport and hobbies Please continue on a separate sheet if necessary and then turn over to complete the Equal Opportunities Questionnaire and Declaration. Page 3 of 5
EQUAL OPPORTUNITIES The University of Warwick and its partner colleges are committed to a policy of equal opportunities and will not discriminate against any applicant or student on the basis of age, gender, nationality, ethnicity or religion. Please help us to make our equal opportunities policy more effective by ticking the boxes below. Arab Asian or Asian-British Bangladeshi Asian or Asian British-Indian Asian or Asian British-Pakistani Black or Black British-African Black or Black British-Caribbean Chinese Gypsy or Traveller Mixed White and Asian Mixed White and Black African Mixed White and Black Caribbean Not known Other Asian background Other Black background Other ethnic background Other mixed background White Gender Male Female If you do not wish to disclose this information, please tick here Religious Belief Buddhist Christian Hindu Jewish Muslim Sikh Spiritual Any other religion or belief Information Refused Sexual Orientation Bisexual Gay man Gay woman/lesbian Heterosexual Other Information Refused PARENTAL EDUCATION The following question is about your parents level of education. This includes natural parents, adoptive parents, step-parents or guardians who have brought you up. Do any of your parents (as defined above) have any higher education qualifications, such as a degree, diploma or certificate of higher education? Yes No Don t know Information refused Page 4 of 5
ADDITIONAL NEEDS We welcome applications from candidates with additional needs and consider them on the same academic grounds as those of other applicants. It is helpful to know in advance if you have any special requirements and the Senior Tutor s Office will be pleased to help assess your needs (024 765 23761). Are you registered disabled? Yes No Do you have a disability/additional needs/medical condition? Yes No If yes, please tick the relevant boxes: Autistic Spectrum Disorder Mental health difficulty Blind/partially sighted Asperger Syndrome Deaf/hearing impairment Personal care support required Multiple disabilities Wheelchair user/ mobility difficulties Other disability A specific learning difficulty, e.g. dyslexia An unseen disability (e.g. Diabetes, epilepsy, asthma) Other additional needs (please specify below) DECLARATION OF CRIMINAL RECORD The University asks all its applicants whether they have any criminal convictions. If you have a criminal record, we can still consider you for a place but the University will ask for details of the offence. Depending on the nature of the conviction, the University may give further consideration to your admission before confirming any offer. You are not required to disclose spent convictions. Do you have any criminal convictions? Yes No DECLARATION Please sign and date your application to confirm that the information you have provided is accurate to the best of your knowledge. Signed... Date...... Please return your completed form to: Admissions Team (Part-Time Degrees), Centre for Lifelong Learning, University of Warwick, Coventry, CV4 7AL or by email to: CLLadmissions@warwick.ac.uk Page 5 of 5