BA/BSc ⃞ FD ⃞

4-Year BA/BSc ⃞ Int’l Foundation ⃞

Level of Entry: Year1 ⃞ Year2 ⃞ Year3 ⃞

Full-time

All information should be provided either typed or in BLOCK CAPITALS

Course title / Course code
PERSONAL DETAILS
Family name
As it appears on your passport:
Title:
Forenames (in full)
As they appear on your passport:
Known as:
Date of birth: / Day: / Month: / Year:
Gender:
Nationality:
Country of permanent residence:
Country of birth:
Highest academic qualification:
Passport number:
Contact details
Home address: / Correspondence address:
Home Tel: / Mobile:
E-mail:
Name of Agency (Where applicable):
Please tick which address you wish us to use: Home ⃞ Correspondence ⃞
Who will pay your fees? SELF ⃞ OTHER ⃞ (please specify):

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Application form - Undergraduate International v2011

PREVIOUS STUDY AND QUALIFICATIONS

Please list in chronological order all academic studies completed, whatever the result, plus any studies currently being pursued. Please attach a certified copy of your certificates and transcripts of all grades obtained.
From
Month/Year / To
Month/Year / Qualification (to be) obtained and major subject / Institution of study / Country of study / Language of instruction / FT / PT

YOU MUST INCLUDE CERTIFIED COPIES OF YOUR EXAMINATION CERTIFICATES AND TRANSCRIPTS WITH YOUR COMPLETED APPLICATION FORM

WORK EXPERIENCE

Please list details of any work experience and attach a CV or summary providing more details if it is relevant to the course you are applying to study
From
Month/Year / To
Month/Year / Name of organisation / Position/Job title / Type of work/Duties / FT / PT

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Application form - Undergraduate International v2011

CANDIDATE’S STATEMENT
Please answer the following questions as fully as possible
Why do you want to do this course?
What do you want to do when you have completed this course?
What interest do you have in the subject?
DECLARATION
Applicants should note that the University is not obliged to provide explanations as to the reasons for accepting or rejecting any particular application.
CONFIDENTIALITY: Applications will be treated in the strictest confidence by the University, and the information given will be used only for the following purposes:
(a) to enable the University to give full and proper consideration to applications, and
(b) for the compilation of essential statistics.
In accordance with the provisions of the 1984 Data Protection Act, no statistical or other information which could identify any individual applicant will be published or otherwise communicated to any other agency.
I certify that all the entries are, to the best of my knowledge and belief, correct, and I undertake, if admitted, to observe the regulations of York St John University.
Signature______Date______

Please reconfirm your personal email address

ENGLISH LANGUAGE SKILLS AND QUALIFICATIONS

If your first language is not English, please indicate your proficiency by completing the sections below.

What is your first language? ______

How often do you use English in a work context?

Daily ⃞ Weekly ⃞ Infrequently ⃞ Rarely ⃞ Never ⃞

How often do you use English in a study context?

Daily ⃞ Weekly ⃞ Infrequently ⃞ Rarely ⃞ Never ⃞

Competence in reading, speaking and writing in English is important; we therefore ask that you demonstrate competence in English by answering the following.

You have been educated entirely in an English-speaking country for at least 1 year: ⃞

You will be taking a recognised English language test (for example, IELTS, TOEFL): ⃞

PLEASE INDICATE THE DETAILS OF YOUR ENGLISH LANGUAGE TEST:

IELTS / Score
Speaking
Listening
Writing
Reading
Overall
Date of test
TOEFL / Score
Computer
Paper
Date of test
TOEFL Internet Based (iBT) / Score
Listening
Structure/Writing
Reading
Overall
Written English test
Date of test
Other (CAE/CPE/PTE etc) / Score/Grade
Date of test

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Application form - Undergraduate International v2011

Equal Opportunities Form

Do you have any criminal convictions? YES ⃞ NO ⃞

Please tick Yes or No depending if you have or have not got a relevant criminal conviction. Relevant convictions are only those convictions for offences against the person, whether of a violent or sexual nature, and convictions for offences involving unlawfully supplying controlled drugs or substances where the conviction concerns commercial drug dealing or trafficking. Convictions that are spent (as defined by the Rehabilitation of Offenders Act 1974) are not considered relevant and you should not reveal them. If you circle yes, you will not be automatically excluded from the application process, however we may ask you for more information. You should be aware that for courses in teaching, health or a course involving work with children or vulnerable adults, any criminal convictions, including sentences and cautions (including verbal cautions), reprimands, final warnings and bind-over orders are exempt from the Rehabilitation of Offenders Act 1974. If you are applying for these courses we will ask you to agree to have a criminal record check. If you are convicted of a relevant criminal offence after you have applied, you must tell York St John University. Do not send any details of the offence, simply state that you have a relevant criminal conviction; we may then ask you more details.

Disability/Special needs

Please enter the appropriate code from the list below: ___

A / No disability
B / You have a social/communication impairment such as Asperger’s syndrome/other autistic spectrum disorder
C / You are blind or have a serious visual impairment uncorrected by glasses
D / You are deaf or have a serious hearing impairment
E / You have a long standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease, or epilepsy
F / You have a mental health condition, such as depression, schizophrenia or anxiety disorder
G / You have a specific learning difficulty such as dyslexia, dyspraxia or AD(H)D
H / You have physical impairment or mobility issues, such as difficulty using your arms or using a wheelchair or crutches
I / You have a disability, impairment or medical condition that is not listed above
J / You have two or more impairments and/or disabling medical conditions

In Care

Have you been in care? YES ⃞ NO ⃞ PREFER NOT TO SAY ⃞

If YES please state the length of time you were in care for: ___ yrs ___mths

Ethnicity

Please enter the appropriate code from the list below: ___

10 / White / 34 / Chinese
21 / Black or Black British - Caribbean / 39 / Asian Other
22 / Black or Black British - African / 41 / Mixed - White and Black Caribbean
29 / Black Other / 42 / Mixed - White and Black African
31 / Indian / 43 / Mixed - White and Asian
32 / Pakistani / 49 / Other Mixed background
33 / Bangladeshi / 80 / Other Ethnic background

Parental education

Do any of your parents have any higher education qualifications such as a degree, diploma or certificate of higher education?

YES ⃞ NO ⃞ DON’T KNOW ⃞ PREFER NOT TO SAY ⃞

DECLARATION SIGNATURE

I certify that all the entries are, to the best of my knowledge and belief, correct.

Signature______Date______


MARKETING INFORMATION

We would welcome your responses in this section.

Information on your application to York St John University is helpful for our programme marketing. Any information that you provide will only be used internally and will not affect the outcome of your application.

Please list, in order of preference with 1 ranking first, any institutions to which you have made an application, including York St John.

1)  …………………………………………………………

2)  …………………………………………………………

3)  …………………………………………………………

4)  …………………………………………………………

Were you recommended to York St John by a former student?

Yes ⃞ No ⃞

If yes, who? ………………………………………………………………………

Please indicate the first and second most important sources of information, using the numbers 1 and 2 which influenced you in applying for a postgraduate place at York St John University. Any additional information you can give us would be helpful.

Press Advert/Article / ⃞ ……………………
Recommendation from student / ⃞ ……………………
Programme leaflet / ⃞ ……………………
University prospectus / ⃞ ……………………
University poster / ⃞ ……………………
University website / ⃞ ……………………
Careers office / ⃞ ……………………
British Council / ⃞ ……………………
Postgraduate fair / ⃞ ……………………
Recommendation from employer/colleague / ⃞ ……………………
Recommendation from tutor/academic / ⃞ ……………………
Other / ⃞ ……………………
Agents name and address (if applicable)


CHECKLIST

Please enclose the following with your application, if possible or submit these as soon as possible otherwise your form may not be considered. Please tick if you have enclosed:

Application form
English Language test results
Copies of Examination Certificates and Transcripts (in original language and translated into English)
Copy of the photograph pages of your passport

English language skills and qualifications form

Equal opportunities form
Marketing information form

Please note: Incomplete applications will cause unnecessary delays in the processing time

THE COMPLETED FORM SHOULD BE RETURNED TO:

Admissions
York St John University
Lord Mayor’s Walk
York

YO31 7EX

United Kingdom

Reference

Your referee should ideally be someone able to comment on any experience or qualifications shown on the application form.

Note to referee: You may continue on a separate sheet if necessary. Please return your reference to the applicant in a sealed envelope to be forwarded with their application.

Name of applicant (block capitals or type) :

Name of referee:
Post/occupation:
How long have you known the applicant?
Relationship to applicant:
Address:
Tel:
E-mail:
Fax:

Referee’s signature______Date______

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Application form - Undergraduate International v2011