Mode of Attendance: Part-Time Distance Learning

Keele Management School & UNITE

Certificate in Union Leadership and Industrial Relations

Course Details

Start Date: February 2015 / Mode of Attendance: Part-time Distance Learning

Personal Details

First Names / Surname/Family Name:
Title: / Gender: / Date of Birth:
Home Address: / Contact Address (if different):
Postcode: / Postcode:
Country: / Country:
Telephone: / Telephone:
Email: / Mobile:
Nationality:
Country of Birth:

Academic and related qualifications

Start Date / End Date / Institution attended and subjects studied / Award

Relevant Employment or Work Experience

Current Employment / Dates / Job Title and brief description of duties
Previous Employment / Dates / Job Title and brief description of duties

Personal Statement

You should state clearly why you are applying for the Certificate Course, the nature of your interest in it, and what benefits you expect to gain. You should also consider what you believe you will be able to contribute to Unite in the future if your application is successful.

References

Please give the name and address of two referees who can comment in confidence on your academic or professional work as appropriate.
Please indicate if you are willing for us to approach your referees: / Yes / No
Referee 1 / Referee 2
Title: / Title:
First Name: / First Name:
Surname/Family Name: / Surname/Family Name:
Address: / Address:
Postcode: / Postcode:
Telephone: / Telephone:
Email: / Email:
Data Protection ActThe information contained in this form will be used for the purpose of processing your application and, if your application is successful, will form the basis of your University record.
University Charter, Statute, Ordinances and RegulationsRegistration at Keele University is conditional upon observation of the University’s Charter, Statute, Ordinances and Regulations in effect at any time. A copy of the current version may be obtained from the University Secretary’s office or is available on the web at www.keele.ac.uk/depts/vc/plansec/regs/reglist.htm
I hereby apply for admission to study at Keele University for the course set out above, and confirm that the information provided is correct to the best of my knowledge.
Signature: / Date:

Return the form:

By post to: Attention of Lynette Lowe UNITE House, 128 Theobalds Road, Holborn, WC1 X8TN

By e-mail to:

You will be sent an e-mail confirmation on receipt of the application.