International Application Form Please complete ALL sections of this form clearly and accurately. If information is missing, or we cannot read some of the sections we will not be able to process your application. When complete, please email your application form to: [email protected]

Section 1: About the course you wish to study 1.

Level of Study …………………………………………………………………………………………………………………….

2.

Title of course …………………………………………………………………………………………………………………….

3.

Month and Year of Entry Sept

4.

Jan

20____

How do you wish to study? Full-time

Part-time

Distance Learning

Section 2: Your personal details 5.

Your surname / family name …………………………………………………………………………………

6.

Your first name(s) ……………………………………………………………………………………………...

7.

Your title:

Mr

8.

Gender

Male

9.

Date of birth (DD/MM/YYYY) …….………………………..……………………………………………....

Mrs

Miss

Ms

Dr

Professor

Other ………………………......

Female

10. Permanent postal address ………………………………………………………………………….…

………………………………………………………………………………………………………….. …………………………………… Postcode …………………………………………………………. 11. Telephone (Including country code) ………………………………………………………………….... 12. Mobile …………………………………………………………………………………..………..….....

13. Email (Please ensure that your email address is very clearly written and is one that you check regularly)

14. Skype ID ……………………………………………………………………………………………………....... 15. Nationality ……………………………………………………………………………………………………… 16. Country of birth ………………………………………………………………………………………………... 17. Which country are you currently living in? ………………………………………………………………... 18. If you were not born in the UK, when did you last enter the UK? Month ………………… Year ………………. I have never been to the UK before

I am currently living in the UK

Section 3: Applying through an Agent or Educational Representative If you are applying via one of our education agents or representatives, please give the name, address of the office and email below: Any correspondence will be sent directly to your chosen Agent or Partner. 19. Agent Country …………………………………………………………..……………………………..……….. 20. Agent Name …………………………………………………………………………………………………..... 21. Address ………………………………………………………………………………………………………… ………………………………………………………………………………….. Postcode …………………… 22. Email

Section 4: Visas and Passports International students who will require a Tier 4 Visa or a Student Visitor Visa to study in the UK must complete the following section: 23. Do you have a current passport:

Yes

No

Passport Number ………………………………

24. Name (as written in Passport) …………………………………………………..……………………………... 25. Passport Country of Issue ……………………………………………………..……………………………... 26. Country of Birth ……………………………………….………..……………………………...………..……… 27. Nationality (as written in passport) ………………………………………………..………..…………………. 28. Will you require a visa (Tier 4 or student visitor) to study in the UK?

Yes

No

If Yes, have you previously studied in the UK with a Tier 4 Visa?

Yes

No

29. Length of Study ………………………………………………………………………..………………..……... 30. Have you previously been refused a visa application to the UK?

Yes

No

If Yes please provide reason and date: ………………………………………………………………………...

Section 5: Your education to date 31. Your education in your home country. Education from the age of 11-18 (enter dates as MM/YYYY) Schools attended

Date started Date finished

Examinations taken and qualifications obtained

Grade

Date

Education since leaving school (Bachelor’s degree, professional qualifications etc.) (Enter dates as MM/YYYY) Institutions attended

Date started Date finished

32. Have you studied in the UK previously?

Examinations taken and qualifications obtained

Yes

Grade

Date

No

It is important you give full information about any studies you have undertaken in the UK as, if you do not, it may impact on your visa information. If yes, please provide details of the course you studied, the dates and the institution. …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………

Section 5: Your work experience/employment history to date 33. Please give details of all the jobs you have held (if any) since the age of 18 If you do not have any work experience, please move on to the next question. If you are applying for a course that specifies work experience as an essential part of the entry criteria (such as the MBA), then please ensure that you provide as much detail as possible about the roles you have held. …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………

Section 6: English language Proficiency 34. Is English your first language?

Yes

No

If NO, complete questions 35 to 45. If YES, skip to section 7. 35. What is your first language? ........................................................................................................................................ Your English qualification 36. Qualification/Name of Test ………………….……………………..……………………..………………….. 37. Test Centre ………………………………………………………………….……………………..…………… 38. Date of Test …………………….……………………..……………………..……………………..…………... 39. Overall result …………………………………………….……………………..……………………..……….. 40. If relevant please specify the individual component results: Reading ………. Writing …………. Speaking ……….. Listening ……….. 41. If you plan to take a test later this year, please tell us which test you will be taking, your predicted grade and the date of your test: 42. Name of test: ………………………………………………………………………………………..…………. 43. Date of test (DD/MM/YYYY) ………………………..……………………..……………………..…………....

English Language Courses. Our dedicated Centre for English Language Learning (CELL) offers a range of courses designed to help you improve your language skills, before and during your studies. If you are unsure which course is most suitable for you visit www.dmu.ac.uk/CELL or email [email protected] for advice. 44. Please tick which course/s you would like to apply for: None – I already have the correct overall English score with level B2 (IELTS 5.5) in each component Intensive General English Course (IGEC): Autumn Term IELTS 3.0-3.5 Spring Term

IELTS 3.5-4.0

English Language Preparation Programme (ELPP): ELPP A

IELTS 4.0-4.5

ELPP B

IELTS 4.5-5.0

ELPP C

IELTS 5.0-5.5

Pre-sessional English Language Course: Pre-sessional English Course

IELTS 5.5-6.0

Pre-sessional English Course

IELTS 6.0-6.5

45. Accommodation for your English language course(s): Please tick the relevant box: I need DMU to arrange accommodation in Halls of Residence for me during my English language course(s). I do not need DMU to arrange accommodation for me during my English language course(s). The English language team will contact you to confirm your English language course and accommodation requirements if your application is successful. Please note that details of applying for accommodation for your main degree course will be sent to you with your offer letter if your application is successful.

Section 7: Personal Statement 46. Please write at least 250 words outlining why you wish to study this course, what skills and knowledge you will bring to the course, what skills and experience you hope to gain during the course, what your longer term career aspirations are and any other additional information in support of your application. (Please attach a separate sheet if required).

…………………………………………………………………………………………………………. …………………………………………………………………………………………………………. …………………………………………………………………………………………………………. …………………………………………………………………………………………………………. …………………………………………………………………………………………………………. …………………………………………………………………………………………………………. …………………………………………………………………………………………………………. …………………………………………………………………………………………………………. …………………………………………………………………………………………………………. …………………………………………………………………………………………………………. ………………………………………………………………………………………………………….

Section 8: Your referees We will need two references to support your application. The references must be on letter headed paper. At least one of your referees should be an academic reference, such as one of your university tutors. Please ask each of your referees to tell us about: Your academic ability and your attitude to study. For example your performance in examinations and other assessments, your contributions to class activities and/or predictions of any results that you are currently waiting for. 47. Referee One

Referee Two*

Name …………………….……………….………...

Name …………………….……………….………....

Institution/company …………………….……….....

Institution/company …………………….………......

Position ……………………….………..……….…..

Position ……………………….………..……….…...

Tel: ……………………….………...……….……….

Tel: ……………………….………...……….……….

Email: ……………………….………...……….……

Email: ……………………….………...……….…….

*Please note that undergraduate applicants only need to provide one reference

Section 9: Payment of your tuition fees 48. Who will pay the tuition fees for your course? Myself

My parents

My employer or other sponsor

Other …………………........

Name and address to which your tuition fee invoice should be sent: ………………………………………………………………………….. ………………………………………………………………….………. ………………………………………………………………………….. ………………………………………………………….………………. E-Mail

Section 10: Supporting disability 49. Please tick from the list below the statement which is most appropriate to you: 000

You do not have a disability, nor are you aware of any additional support requirements

010

You have dyslexia

020

You are blind/partially sighted

030

You are deaf/have a hearing impairment

040

You are wheelchair user/have mobility difficulties

070

You have an unseen disability (e.g. diabetes, epilepsy, asthma)

080

You have two or more of the above difficulties/special needs

090

You have a disability not listed above (please give details on a separate sheet)

Does your disability mean that you have additional support needs?

Yes

No

If yes, we will contact you to determine appropriate support for you. The University welcomes applications from disabled international students and we encourage you to declare your disability and your support needs as soon as possible. Telling us about your disability will not affect your selection as a student, but will enable us to work with you to assess your needs, plan your stay at the University and inform you to what extent we can meet your requirements. When you are thinking about the support you will require, please think carefully about the informal help that you currently get from family and friends, and include this in your financial calculations. The more information you give to the Disability Advice and Support the clearer idea of your support requirements we will have and how we can work with you to access support.

Section 11: Planning Statistics 50. Please choose from the ethnic origin terms below which you feel most nearly describes your ethnic origin. Ethnic origin (this information WILL NOT be made available to Admissions Tutors for selection purposes) White

Black or Black British

Asian or Asian British Mixed

Other

British

Caribbean

Indian

White and Black Caribbean

OtherEthnic Background

Irish

African

Pakistani

White and Black African

Not Given (UK domicile)

Other

Other Black

Bangladeshi

White and Asian

Overseas Domicile

Chinese

Other Mixed

Other Asian

Section 12: Market Research 51. In order to assist us to market our courses more effectively, could you please specify how you came to hear of our course? TV Advert

Radio Advert

Press Advert

Prospectus

Course Leaflet

Overseas Agent

Friends/Family

Careers Office

Careers Fair

Live Locally

DMU Website

Other Website

At University

At Work

Other

Section 13: Criminal Convictions 52. The University asks applicants to disclose information about any relevant unspent criminal convictions. Do you have an unspent conviction?

Yes

No

You must inform us about any convictions you have that are not ‘protected’ as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013) by SI 2013 1198.

Section 14: Declaration 53. By submitting this form I declare that, to the best of my knowledge, the information I have given above is correct in every detail. If enrolled, I agree to abide by the Regulations in force at the time. Signed …………………………………………………

Date: (DD/MM/YYYY) ……………………………….

If your application to De Montfort University is unsuccessful and we can suggest an alternative on-campus pathway programme, we would like to forward your application to Leicester International Pathway College. If you do not want us to do this, please tick this box When complete, please E-mail the application form to [email protected]

Please send copies of the following information with your application form: • Evidence of your academic qualifications to date (normally all your study results from the age of 16). • Evidence of your English Language ability (if English is not your first language) – this might be an IELTS test certificate, a transcript showing that your degree has been studied in the medium of English from a majority speaking English Language country or similar. • Two supportive written references. These should normally be from your current or most recent tutor(s) and/or employer. At least one reference should be an academic-related reference from a tutor who can talk about your study ability and English language ability (if English is not your first language). If you are still waiting for exam results or English language test results, then please state this in your application and we will ask you for evidence of achievement when it is available later in the year. Please send photocopies only at this stage – we will ask to see your original documents at enrolment. If you have any queries about completing this form, please contact our International Admissions Office on +44 (0)116 257 7713 or email [email protected]. Please make sure that you include a current email address in your application form and make sure that you check this email address regularly – all information relating to your application, including any offer letters, will be sent by email.