Please read the accompanying guidance notes before completing this form. The notes explain each section of the form and set out the terms and conditions to which you must agree.
1. Personal details
Surname: / Click here to enter text. /
Forename: / Click here to enter text. /
Home address: / Click here to enter text. /
Contact numbers:
(inc. country/area code) / Home: / Click here to enter text. /
Mobile: / Click here to enter text. /
E-mail: / Click here to enter text. /
2. Equal opportunities monitoring
Note to administrator: this section should be redacted before forwarding to the academic department.
Sex: / ☐ / Male / ☐ / Female
Date of birth: / Click to enter date. /
Country of permanent residence: / Click here to enter text. /
Country of birth: / Click here to enter text. /
Nationality: / Click here to enter text. /
Disability:
(optional) / ☐0 / ☐2 / ☐4 / ☐6 / ☐8 / ☐T
☐1 / ☐3 / ☐5 / ☐7 / ☐9
Details: / Click here to enter text. /
Ethnicity:
(optional) / ☐11 / ☐19 / ☐22 / ☐31 / ☐33 / ☐39 / ☐42 / ☐49
☐12 / ☐21 / ☐29 / ☐32 / ☐34 / ☐41 / ☐43 / ☐80
3. Programme details
Programme of research: / ☐ / MRes
☐ / Professional Doctorate. Please specify: Click here to enter text.
☐ / PhD
Mode of study: / ☐ / Full-time / ☐ / Part-time
Intended start date – September: / Year:e.g. 2016, 2017, 2018, etc..
Intended academic department: / Click here to enter text. /
Intended supervisor (if any): / Click here to enter text. /
4. Fee payment arrangements
How will you be funding your studies? / ☐ / Self-funded
☐ / Sponsored by employer/other organisation (e.g. studentship)
Please provide details of your sponsor/studentship (inc. if funding is already in place or your application is pending):
Click here to enter text. /
5. Further details
Name of Education Agent/Representative:
(if applicable) / Click here to enter text. /
Agent e-mail address: / Click here to enter text. /
Your correspondence address:
(if different from home address) / Click here to enter text. /
Passport number: / Click here to enter text. /
Place of issue: / Click here to enter text. /
Date of issue: / Click to enter date. /
Residential category:
(see guidance) / ☐A / ☐B / ☐C / ☐D / ☐E
☐F / ☐G / ☐O / ☐Z
Have you been a student in the UK before? / ☐ / Yes / ☐ / No
6a. Education
A-level or later (inc. relevant professional qualifications). Please start with your most recent.
Name & address of school/college/university / Qualification/level
(e.g. A-level, High School diploma, IB, BSc, MA) / Subjects & grades/results
(e.g. English (A), etc.) / Date of award
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click to enter date. /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click to enter date. /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click to enter date. /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click to enter date. /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click to enter date. /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click to enter date. /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click to enter date. /
6b. English Language Qualification(s)
Where taken (country) / Qualification/level
(e.g. IELTS, TOEFL, Pearson) / Grade/result
(Overall score and score for each element) / Date taken
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click to enter date. /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click to enter date. /
7. About you
Please tell us more about you and, in particular, why you want to undertake this programme. Please include details of:
- Why you are applying to Edge Hill University
- Which personal qualities you possess will help you succeed on this programme
- What impact you think this will have on you e.g. future career, etc.
- Any employment or other work experience that is relevant to your application.
Click here to enter text. /
8. Academic references
Please provide details of your academic referees (see guidance notes).
You will need to ask your referees to complete the separate reference form. They must then send them directly to us themselves.
Referee 1 / Referee 2
Title: / Click here to enter text. / Click here to enter text. /
Full name: / Click here to enter text. / Click here to enter text. /
Address: / Click here to enter text. / Click here to enter text. /
Telephone: / Click here to enter text. / Click here to enter text. /
E-mail: / Click here to enter text. / Click here to enter text. /
9. Criminal convictions
Do you have any criminal convictions? / ☐ / Yes / ☐ / No
10. Document checklist
Please submit the following with your application:
☐ / Research proposal
☐ / Copies of academic qualifications
☐ / Copy of passport photo page and any previous UK visas if studied in the UK before
☐ / Copy of English language qualifications
☐ / Studentship applicants: any other document(s) specified in the advertisement
Please also ask your referees to send completed reference forms to us.
11. Declaration
I confirm that the information and details I have given on this form are true, complete and accurate and that no information or other significant details requested have been omitted.
I have read the guidance notes, understand what they say and agree to abide by the conditions set out therein, which I accept as the conditions of this application.
I agree to Edge Hill University holding, processing and disclosing my information for the purposes outlined in the guidance notes.
I agree to being contacted by Edge Hill University by post, telephone, email or text in connection with this application.
☐Please tick this box if you do not wish to be contacted by Edge Hill University with any commercial information or details of other services or products not directly related to the course(s) applied for.
Applicant’s signature
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Date:Click to enter date.
Your completed application & documents should be returned via email to:Non-EU applicants:
Alternatively, they can be posted to the
International Office (if non-EU):
Edge Hill University
St Helens Road
Ormskirk
L39 4QP
UNITED KINGDOM
OFFICE ONLY
STUDENT NUMBER Click here to enter text.
AGENT CODE Click here to enter text.
Template updated: 12 May 2017
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