Academic Enrolment Form
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Maintained by: Registry; Last updated: Nov 2011

Student Name and Permanent Address / Student ID
Surname / Title: [Mr] [Mrs] [Miss] [Ms] [Other]
Forenames / Home Address
Forename Used
Gender
Date of Birth / _ _ / _ _ / 19 _ _ / Postcode
Home Telephone / Student Support No.
Personal E-mail Address
Student Workplace Address / Contact Details (for use in emergency only)
Relationship / Title
Surname
(Postcode) / Forename
Employing Trust (essential) / Contact Phone
Work Telephone No. / Your Mobile Phone No.
Course Details
Course Start Date / Mode of Attendance
Course Title
Route Title
Other Details
Ethnicity
Nationality / UK / Other
Country of Usual Residence / England / Other
Do you have a disability? / Yes / No
What is the nature of your disability?
Do you receive Student Disability Allowance? / Yes / No
Academic Enrolment Form
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QA Ref: STU9i; Maintained by: Registry; Last updated: Nov 2011

Other Details (continued)
Is this your first year in Higher Education? / Yes / No
Highest qualification on entry
If you already have a HESA id (a 13 digit number), please enter it here
If you have a Unique Learner Number (ULN), please enter it here
Last School / FE / HE Institution
The following question is about your parents’ level of education. This includes natural parents, adoptive parents, step-parents or guardians who have brought you up.
Do any of your parents (as defined above) have any higher education qualifications, such as a Degree, Diploma or Certificate of Higher Education? / Yes / No
Term-time Accommodation
Please indicate where you will be living during the current academic year. (If you are in temporary accommodation at present, but have permanent accommodation agreed, pleased enter the planned accommodation here.)
Parental/guardian home
Own residence, either owned or privately rented by you
Other rented accommodation
(“Other rented accommodation” refers to a more temporary arrangement, for example where you and other students rent a room I the same house on a yearly, or shorter, basis.)
Other accommodation
Other
Are you happy for your contact details to be passed to the YSJ Student Union? / Yes / No
Would you like the YSJ Chaplaincy and Spiritual Care team to contact you? / Yes / No
Declaration
I have checked that these details are correct. I understand that this personal information will form the basis of the computer record used by management for all aspects of my course at the University and that the information from the record will be disclosed in official statistical returns required of the University.
I acknowledge and agree to comply with all University rules, regulations and policies as detailed in the Student Policies and Procedures document on the University website. (To view the Student Policies and Procedures pages, please see
Signature
Date