LTHE Level 7 Application Form1

Application Form for LTHE Level 7 Programme 2017/18

Course Code P1S0EDUEDU01

This form must be completed by all applicants wishing to enter the LTHE Level 7 Programme. Please see the LTHE web pages at for further information.

Fields marked with an * are required by the Higher Education Statistics Agency (HESA) for use in statistical analysis.

PERSONAL DETAILS

*Surname or Family Name: / *Forenames (in full):
Title (Mr/Mrs/Ms): / Email:
*Family name on 16th Birthday: / *Gender FEMALE / MALE
*Date of Birth (dd/mm/yy): / Telephone (day):
Telephone (evening):
*Address for correspondence: / *Post Code:
*Nationality (e.g. British): / *Domicile:
a) University Student Number (if a previous student with Exeter): / b) DfES/GTC No:
*Unique Learning Number (if applicable): / *Do you have Qualified Teacher Status? YES / NO
*Are you disabled?YES / NO
If you have answered YES, what is the nature of your disability? (Please tick as appropriate):
01Dyslexia / 06Mental health difficulties
02Blind/partially sighted / 07An unseen disability (e.g. diabetes, etc.)
03Deaf/hearing impairment / 08Multiple disabilities
04Wheelchair user/mobility difficulties / 09A disability not listed above
05Personal care support / 99Prefer not to say
TAutistic Spectrum Disorder or Asperger Syndrome
The University welcomes and supports students with disabilities. As part of our commitment, a member of staff may contact you to discuss the specific arrangements and resources available to assist you in your studies.
If you would prefer NOT to be contacted to discuss your disability, please tick. / *Are you in receipt of a Disabled Students’ Allowance?
YES / NO
Please use a separate sheet if you wish to give more information about your disability.
*Ethnic Origin - (Please tick as appropriate):
11White British / 32Asian or Asian British - Pakistani
19Other White background / 33Asian or Asian British - Bangladeshi
21Black or Black British - Caribbean / 34Chinese
22Black or Black British - African / 39Other Asian background
29Other Black background / 80Other (please state)
31Asian or Asian British - Indian / 98Prefer not to say

EDUCATIONAL EXPERIENCE

*Highest Qualification On Entry (e.g. BA, BSc, etc):
PLEASE NOTE: continuing students need not complete this section
Dates of
Attendance / University or
College / Main Subject / Qualification / Award Date
If English is not your first language please visit our website for details of English Language requirements.
Please give full details of any English Language Qualifications that you hold, including scores:

*Have you ever attended a higher education course (i.e. above A level or Equivalent) in the UK before, for 6 months or more? YES / NO

*Do any of your parents (natural parents, adoptive parents, step-parents or guardians who have brought you up) have any higher education qualifications, such as a degree, diploma or certificate of higher education?

YES / NO/ Don’t Know / Info Refused

TERM TIME ACCOMMODATION

1 / University of Exeter Halls of Residence
2 / Parental/ Guardian home
4 / Other
6 / On language year abroad or placement
7 / Own Residence - rented or owned
8 / Rented accommodation - share with other students
9 / Privately run Halls of Residence

YOUR STUDENT UNION MEMBERSHIP OPTIONS

If you do not wish to be a member of the Students' Guild throughout your studies please inform us by selecting Opt Out. If you opt out we will ensure that your details are not passed to the guild for their membership or survey purposes. Please note that your UniCard will display the Guild logo regardless of whether you opt out.

Opt In/Opt Out

I would like to join and you MAY release disability/ethnicity data to the Guild

I would like to joinbut please DO NOTrelease disability/ethnicity data to the Guild

I do not wish to join the Guild. Please do not release any data

CRIMINAL CONVICTIONS

Please read the guidance below. You should tick the box only if you have a relevant criminal conviction that is not spent.

To help to reduce the risk of harm or injury to our students and staff caused by the criminal behaviour of other students, we must know about any relevant criminal convictions that an applicant has.
Please read the following carefully.
If you tick the box above you will not be automatically excluded from the application process.
What does ‘spent’ mean?
If a person does not re-offend during their rehabilitation period, their conviction becomes 'spent' (as defined by The Rehabilitation of Offenders Act 1974). Convictions that are spent are not considered to be relevant and you should not reveal them. You should note that certain offences are never spent.
Also, for certain courses, you are required to declare all convictions whether spent or unspent. These do not have to bedeclared in answer to this question which relates only to relevant, unspent criminal convictions but you must reveal them if a course has been denoted as requiring a criminal records check. You will be asked this question when you choose a relevant course.
For more information on offences and rehabilitation periods, click on
What is the Rehabilitation of Offenders Act 1974?
The Rehabilitation of Offenders Act 1974 aims to help people who have been convicted of certain criminal offences and have not re-offended since being convicted. People with few or minor convictions will therefore be able to ‘put their past behind them and be treated as everyone else with regard to employment and equal opportunity.
What is a relevant criminal conviction?
Relevant criminal offences include convictions, cautions, admonitions, reprimands, final warnings, bind over orders or similar involving one or more of those listed below.
• Any kind of violence including (but not limited to) threatening behaviour, offences concerning the intention to harm or offences which resulted in actual bodily harm.
• Offences listed in the Sex Offences Act 2003.
• The unlawful supply of controlled drugs or substances where the conviction concerns commercial drug dealing or trafficking.
• Offences involving firearms.
• Offences involving arson.
• Offences listed in the Terrorism Act 2006.
If your conviction involved an offence similar to those set out above, but was made by a court outside of Great Britain, and that conviction would not be considered as spent under the Rehabilitation of Offenders Act 1974, you should tick the box. Warnings, penalty notices for disorder (PNDs), anti-social behaviour orders (ASBOs) or violent offender orders (VOOs) arenot classed as convictions for the purpose of this section, unless you have contested a PND or breached the terms of an ASBO or VOO and this has resulted in a criminal conviction.
How will you handle my application if Ideclare a relevant criminal conviction?
If you tick the box you will not be automatically excluded from the application process.
The information concerning criminal convictions will be passed to appointed persons at the University. In line with bestadmissions practice, they will consider your application separately from your academic and achievement merits. During thisconsideration, they may ask you to provide further information about your conviction. If they are satisfied, your application will proceed in the normal way although they may add certain conditions to any offer they may make. Otherwise they will notify you of their decision.
Failure to declare a relevant criminal conviction may result in expulsion from the University of Exeter.
All information concerning criminal convictions must be treated sensitively, confidentially and managed in accordance with the Data Protection Act 1998.
Further details are also available via
What if I receive a relevant criminal conviction afterI have applied?
If you are convicted of a relevant criminal offence after you have applied, you must tell us. Do not send details of the offence; simply tell us that you now have a relevant criminal conviction. We may then ask you for more details.

STUDENT DECLARATION

Data Protection Notice -- The University of Exeter requires this information for education purposes and your personal data will be processed in accordance with the University's Registration and Current Data Protection legislation. This information will not be disclosed to any unauthorised third parties. To receive a copy of our data protection notice please contact us.

The University will disclose information about your disability to internal personnel and departments only, such as the AccessAbility service and internal service providers etc., to assist you in your studies.

If you do NOT want your personal information processed in this way please tick.

I agree to abide by the regulations of the University and to accept the jurisdiction of the Senate. I confirm that the information on this form is correct to the best of my knowledge. I understand that credit-bearing courses include some form of assessment as an integral part of the course.

Signature: / Date: