De Montfort University
Faculty of Health and Life Sciences
Application and Enrolment Form for:
MSc/PgDip/PgCert/Pg Institutional Credits in
Quality by Design for the Pharmaceutical Industry (DL)
2016-17
Applicant ChecklistBefore submitting this form please make sure all sections are completed.
Have you included photocopies of your educational certificates?
If your first language is not English, have you enclosed proof of your English language proficiency?
Have you enclosed your reference?
Have you included 2 passport sized photographs and written your name and date of birth on the back of them? An electronic photo is accepted. Please email it with this application.
Please return the completed form to:
Admissions Department
De Montfort University
Edith Murphy House, Room 0.23
The Gateway
Leicester
LE1 9BH
PLEASE COMPLETE ALL THE SECTIONS ON THIS FORM
Programme Code: / H81272Programme Title: / Quality by Design for the Pharmaceutical Industry / Faculty / HLS
How are you studying? / Distance Learning / ü / Are you graduating this year? / Yes / No
Start date: / October 16 / Award Aim / Postgraduate Institutional credits
Postgraduate Certificate
March 17 / Postgraduate Diploma
MSc
Have you previously studied at DMU? / Yes / No
If yes, what is your previous student number? / P
Title / First name(s) / Surname
Previous Surname (if applicable)
Date of Birth / D / D / M / M / Y / Y / Y / Y / Gender / Male / Female
Permanent Home Address:
Postcode: / Home Tel:
Personal email: / Mobile Tel:
Term Time Address:
(if different from home)
Postcode: / Work Tel:
Work email:
Term Time Type of Accommodation
Halls of Residence / Parent/guardian Home / Own Home / Private Rented / Other
Term Time Council Tax Authority
Leicester / Blaby / Oadby & Wigston
Charnwood / Hinckley / Other (please specify):
Emergency Contact
(We will inform your contact if your well-being is threatened and you are unable to give instructions)
Contact Name
Contact Telephone
Relationship to You
Country of Normal Residence
England / Scotland / Wales / N.Ireland / Ireland
France / Libya / China / Hong Kong / Thailand
Greece / Poland / Nigeria / Cyprus / Saudi Arabia
Germany / India / Denmark / Taiwan / USA
Pakistan / Other (please state):
Country of Birth
Applicants not born in the United Kingdom please state date of last entry to UK: / D / D / M / M / Y / Y / Y / Y
Nationality (i.e. what is on your passport)
British / Irish / French / German / Portuguese
Ghanaian / Dutch / Greek / Polish / Nigerian
Taiwanese / Libyan / Saudi Arabian / Cypriot / Pakistani
Zimbabwean / Chinese / Indian / Italian / American
Other (please state):
Ethnic Origin
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
Mixed – White and Asian / Mixed – White and Black
African / Mixed – White & Black Caribbean
Other Asian Background / Other Black Background / Other Ethnic Background
Other Mixed Background / Other White Background / White – Welsh
White – Irish / White – Scottish / Information Refused
White – English / White – Northern Irish
Not known / Other please state:
Disability/Medical Conditions (please tick all that apply)
No known Disability / Deaf / Have Hearing Impairment
Asthma / Diabetes
Wheelchair User / Have Mobility Issues / Epilepsy
Dyslexia / Specific Learning Differences / Personal Care Support
Blind / Are Partially Sighted / Chronic Fatigue Syndrome
Mental Health Issues / Other (please state below)
Repetitive Strain Injury
Autistic Spectrum Disorder / Asperger Syndrome
Does your disability mean that you have additional support needs? If yes, we will contact you to determine appropriate support for you. / Yes / No
Are you in receipt of Disabled Student Allowance (DSA)? / Yes / No
If you need advice about how to apply for the Disabled Student Allowance (DSA) then please contact Disability Advice and Support on 0116 257 7595
Previous Higher Education Experience
Do any of your parents or guardians have any higher education (HE) qualifications? i.e. degree, diploma or certificate of HE. / Yes / No / Don’t know / Information refused
Qualifications gained post 16 years of age – (i.e. AS/A Levels, Scottish/Irish/Welsh equivalents, BTEC, Foundation, Key Skills, IB etc)
Subject / Qualification Type i.e. A-level, BTEC / Grade / Year Completed
Previous Educational Institution
Name: / Town/City: / Year Left:
Faculty of Health and Life Sciences Application and Enrolment Form - Page 1 of 9
All Previous Qualifications – please tick ALL the qualifications you haveLevel 8 / Level 3
UK doctorate degree (PhD) / Mixed Level 3 qualifications subject to UCAS Tariff points
EU doctorate degree / Mixed Level 3 quals not subject to UCAS Tariff points
Overseas, Non-EU doctorate degree / BTEC Diploma at Level 3
Other qualification at level 8 / BTEC Certificate at Level 3
Level 7 / BTEC Award at Level 3
UK masters degree / AQA Baccalaureate (Bacc)
EU masters degree / A-Level or AS Level
Overseas, Non-EU masters degree / EU A/AS level equivalent
Integrated UG/PG taught masters degree / Overseas, Non-EU A/AS level equivalent
PG Diploma / 14-19 Advanced Diploma (level 3)
PG Certificate / Scottish Highers
PG Cert or Prof Graduate Diploma in Education / Scottish Baccalaureate
Qual leading to registration with Architects Reg Board / International Baccalaureate (IB) Diploma
Professional qualifications at PG level (ACCA/CIMA) / International Baccalaureate (IB) Certificate
Other taught qualification at Level 7 / Cambridge Pre-U Diploma
Taught work at level 7 for Institutional credit / Cambridge Pre-U Certificate
MPHARM / Welsh Baccalaureate Advanced Diploma (level 3)
Level 6 / Foundation at level 3 (FE) (ie. Art & Design)
UK degree with honours / Other Qualifications at Level 3 (i.e. BTEC Nationals, NVQ, GNVQ)
EU degree / BTEC National Diploma (Incl. ‘Early years’)(level 3)
Overseas, Non-EU degree / BTEC National Certificate (level 3)
Degree with honours leading to QTS status / BTEC National Award (level 3)
Professional qualifications at UG level / Level 2
Professional Graduate Certificate in Education / 14-19 Higher Diploma (level 2)
Other Qualification at Level 6 / Welsh Baccalaureate Intermediate Diploma (level 2)
Level 5 / GCSE/O Level
UK ordinary (non-honours) degree / Scottish ‘O’ grades and standard grades
EU ordinary (non-honours) degree / Other Qualification at Level 2 (ie. NVQ/GNVQ Intermediate)
Overseas, Non-EU ordinary (non-honours) degree / BTEC First Diploma (level 2)
Foundation degree
Diploma of Higher Education (DipHE) / BTEC First Certificate (level 2)
Higher National Diploma (HND) / BTEC First Award (level 2)
Foundation course at level 5 / Level 1
Certificate/Diploma in Education (non-graduate ITT) / 14-19 Foundation Diploma (level 1)
Other Qualification at Level 5 (i.e. NVQ, BTEC, ACCA/CIMA) / Welsh Baccalaureate Foundation Diploma (level 1)
Level 4 / Other Qualification at Level 1
Certificate of Higher Education (CertHE) / Other
Higher National Certificate (HNC) / Higher education (HE) Access Course, QAA recognised
Higher Apprenticeship (level 4) / Higher education (HE) Access Course, not QAA recognised
Other qualification at Level 4 (i.e. NVQ, SQA, UCPD) / Previous experience and/or admissions test
Undergraduate Credits / Other qualification level not known
No formal qualification
General guidance to levels:
Level 1 and 2 - usually taken in secondary education (UK school)
Level 3 – usually taken in further education (FE college)
Level 4, 5 and 6 – usually taken in higher education (University at undergraduate level)
Level 7 and 8 – usually taken in higher education (University at postgraduate level)
English Language Proficiency
What is your first language?
If your first language is not English, please give your score for either of the following, if applicable:
Please attach evidence of this to your application form: / IELTS score / TOEFL score
If you have not taken an English language test yet, what date do you plan to take it?
What other English language qualifications do you hold?
How many years have you studied English language?
Have you been taught in English in your home country? / Yes* / No
*If Yes, please give details:
Supporting Statement
Why do you wish to study this course? (Please use additional paper if necessary)
Under 21 please list occupation of highest paid parent/guardian
21 or over please list your current or previous occupation.
Would you describe yourself as having been in care on or after your 16th birthday? / Yes / No / Don’t know / Information refused
Employment Background (including current employer)
Employer / Position / Date from/to
Reference
You should now ask your Line Manager/Employer to provide a reference on letter-headed paper of the organisations they represent, to the address on the front of this form as soon as possible. They should clearly state your name, DOB and course and should be stamped with the company stamp if possible. Emailed references are acceptable provided they are from a professional source.
Referee Information / Name / Position
Address
Telephone
Relationship to you / Known Since
Criminal Convictions
The University must know about any unspent criminal offence information about you. Please read the following carefully.
If you have any unspent offence(s) to declare please tick the box below. If you tick the box you will not be automatically excluded from the application process. However we may need to contact you for further information about this.
Please familiarise yourself with the University’s criminal record process - full details can be found within our Admissions Policy on our website at www.dmu.ac.uk.
Fees - You are responsible for your fees irrespective of who is paying.
Who is expected to pay fees? / Applicant / Employer/Sponsor
If you are being paid for by your Employer/Sponsor please provide the following details:
Company Name:
Company Address:
Contact Name of person responsible for fees:
Contact details / Email: / Telephone number:
Company reference number/purchase order number:
If your fees are being paid for by your Employer or a Sponsor, you must have an official letter from them confirming the details of their sponsorship of your studies and the amount they are funding you for. Please return this letter with this application/enrolment form. If you do not have this letter yet, please submit it as soon as possible to the address on the front of this form.
Please see below the fee for the programme modules for your information:
Module / Title / Credits* / Fees/£**1 / Principles and Tools of Quality by Design / 30 / 1,485
2 / The QbD Product Development Roadmap / 30 / 1,485
3 / Quality by Design in Practice / 30 / 1,485
4 / Manufacturing, Process Controls and Regulatory Affairs / 15 / 1,050
5 / Negotiated Studies (option: e.g. QbD for Biopharmaceuticals) / 15 / 1,050
6 / Research Methods / 15 / 1,050
7 / Work-based Dissertation / 60 / 2,150
Total available / 195 / 9,755
Total for full MSc / 180 / £8,705
*For the MSc, the students need to complete 180 credits from the 195 credits available.
** Discounts maybe available – please contact Dr Walkiria Schlindwein
Data Protection Act Statement, Student Declaration and sharing your Learner Record
I understand that by signing this form I am agreeing to be liable for all tuition fees incurred over the duration of my programme of study, in whole or in part, and that if I or my sponsor fail to pay my tuition fees in a timely manner that DMU reserves the right to terminate my studies. I understand that De Montfort University reserves the right to prosecute me in order to recover any debt. I understand that should I wish to leave DMU before the end of my programme of study I am responsible for contacting the University to terminate my enrolment and that I am liable to incur costs equating to up to a full year of tuition fee if my registration is terminated by DMU on my behalf.
For students studying at DMU on a visa issued by the UKVI only – I agree to abide by the terms of my visa and I understand that should DMU have any concerns about this and/or my attendance on the course, I will be reported to the UKVI.
In accordance with the Data Protection Act 1998 the University requires your consent to collect and use personal information.
I agree to De Montfort University processing personal data contained in this form or other data which the University may obtain from time to time from me or other people whilst I am a student as listed in the online document “How We Use Student data”, available on the DMU website at http://www.dmu.ac.uk/studentdatause . I agree to the processing of such data for any purpose connected with my studies, including placements or my health and safety.
The Learning Records Service (LRS) programme offers a service to allocate Unique Learner Numbers (ULNs) to students. The ULN enables individuals to access a Learner Record which will offer learners the facility to access their participation and achievement data via a website and to share this with other organisations and individuals where permission is granted. At no time will your personal information be passed to organisations for marketing or sales purposes. Individuals can opt out by ticking this box. o More information can be found at www.miap.gov.uk.
I declare that the information contained in this form is correct and understand that if I have knowingly given false information I may be excluded from De Montfort University. I agree to abide by the University’s regulations. I understand that the programme for which I am enrolling is subject to availability.
Signed by Applicant / Date / D / D / M / M / Y / Y / Y / Y
Academic Signature: / Name
Decision / Date:
Admissions / Recorded and acknowledged / Date / Initials / Status -Home/EU/Overseas
ELQ / Y/N / Photos / ID Card / Sponsor letter / Fees / £
Discount / £
Faculty of Health and Life Sciences Application and Enrolment Form - Page 1 of 9