/ APPLICATION FORM
PG Cert / PG Dip / MA
Special and Additional Learning Needs
A collaborative international programme jointly provided by the University of East London and ICEP Europe /
NOTES FOR COMPLETING THIS APPLICATION FORM.
Please ensure that you complete all of the compulsory sections marked * and all other questions relevant to you.
Please return this form as an e-mail attachment to , or you can print it out and send by surface mail to the contact address in Section 15 of this form.
Closing date for returning form: 21th December 2017. (Late applications may be considered if places are available).
Module Fee: The module fee of £1,060 is payable on acceptance to the module.
If you have any problems completing this form email or call + 44 (0)208 354 7592
1. Level Of Study
* Start year / * Start month
(Please tick ONE only) / * Which level are you applying for?
(Please tick ONE only)
YYYY / January / PG Cert / MA
September / PG Dip
Note: If you select PG Cert or PG Dip you need to reapply for the MA
2. Personal Details / Previous Enrolment
* Title (e.g. Mr, Mrs, Miss, Ms, Dr etc) / * Have previously studied at or applied to UEL? (Tick only ONE)
* Surname / Family Name / Yes / No
If yes, please enter your 7 digit reference/student number
* First / Given Name
* Date of Birth / If you would like to nominate someone that UEL can discuss your application with, please state their name here
DD/MM/YYYY
* Gender Identity (Tick ONE only)
Male / Female / Other
OFFICE USE ONLY
Date of Receipt:
DD/MM/YYYY / Decision and Conditions (if any) / Date of Decision:
DD/MM/YYYY
Initials:
3. Your current address / Your contact details
* Address Line 1 / Home Telephone number (including country dialling codes)
* Address Line 2 / Mobile number (including country dialling codes)
* Town / Email address
County (if applicable)
Postcode / Zip code (if applicable)
* Country
4. Essential additional information. All applicants to complete.
* Country of Birth / * Nationality as it appears / would appear on your passport
* Country that you normally live in
If you are currently living in UK/European Union (EU) or European Economic Area (EAA)
and this is not your country of residence, please state the date of your first entry to the UK/EU/EAA / DD/MM/YYYY
* How did you hear about this course?
Direct mail / post / Email marketing
Google search / Masterstudies.com
Magazine/newspaper advert / Facebook
Other (please specify)
Please answer the questions below:
Have you been living in the UK/EU/EAA continuously since this date? / YES / NO
What was your main purpose for coming to the UK/EU/EAA?
Did you require a student visa for entry to the UK? / YES / NO

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5. Employment
* Employment history (complete if applicable in date order starting with the most recent)
Employer and type business / Position held / Job title / Brief description of role / duties / responsibilities / Start date: / End date
MM/YYYY / MM/YYYY
MM/YYYY / MM/YYYY
6. References
* Please provide details of two referees one, at least, must be an academic referee. Please note references from family members will not be accepted.
Name / Company/ Organisation/ Educational institution / How do they know you? / Address / Telephone number and e-mail (including country codes if not in UK)

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7. English Language and Mathematics Qualifications

Qualification and awarding body
(eg GCSE, AQA) / Subject (eg English/ mathematics) / Results (all components) / Date completed / expected to complete
MM/YYYY
MM/YYYY
MM/YYYY
MM/YYYY
MM/YYYY
If you will/have taken an IELTS test, please enter your TRF number here:
8. Education / Qualifications

* Qualifications (Please list below in date order starting with the most recent)
University / College / School / Qualification AND awarding body / Subject(s) / Results
in full / From: / To: / What language
was this
assessed /
examined in?
MM/YYYY / MM/YYYY
MM/YYYY / MM/YYYY
MM/YYYY / MM/YYYY
MM/YYYY / MM/YYYY
MM/YYYY / MM/YYYY
MM/YYYY / MM/YYYY
9. Personal Statement

*Statement. Please enter your Personal Statement below
10. Additional Needs

Do you have any disabilities or additional educational needs? Please tick ONE box only.
No disability / Learning difficulty / Blind/partial sight / Deaf/partial hearing
Wheelchair/mobility / Personal Care Support / Mental health / Unseen disability
Multiple disabilities / Autistic Disorder
Other disability / (Please specify)
11. Criminal Conviction

* Do you have a relevant criminal conviction?
YES: / NO:
12. Module choice

INITIAL MODULE CHOICE
Please indicate your module choice by checking ONE BOX ONLY for each semester.
SEMESTER B (Beginning Jan) / SEMESTER C (Beginning May) / SEMESTER A (Beginning Sept)
ET7900 Dyslexia and Literacy: Issues, perspectives and Best Practice
ET7901 Autism Spectrum Disorders: Contemporary Perspectives and Best Practice
ET7902 Inclusive Education: Collaboration and Best Practice
ET7903 Understanding Behaviour: Theories, Perspectives and Best Practice
ET7904 Exceptionally Able Learners: Theories, Perspectives and Best Practice
ET7905 Applied Behavioural Analysis; Critical Exploration and Practice
ET7746 SEN research methodologies and dissertation
(SEN research methodologies and dissertation for MA only)
(Note: Modules will be available during each semester subject to minimum participant numbers)
Please indicate all modules you wish to take for your future semesters
Future semesters
ET7900 Dyslexia and Literacy: Issues, perspectives and Best Practice
ET7901 Autism Spectrum Disorders: Contemporary Perspectives and Best Practice
ET7902 Inclusive Education: Collaboration and Best Practice
ET7903 Understanding Behaviour: Theories, Perspectives and Best Practice
ET7904 Exceptionally Able Learners: Theories, Perspectives and Best Practice
ET7905 Applied Behavioural Analysis; Critical Exploration and Practice
ET7746 SEN research methodologies and dissertation
(SEN research methodologies and dissertation for MA only)
13. Submission

Signature/Name: / Date:
DD/MM/YYYY
14. How we will use the information that you provide on this form
15. Further enquiries:

Antoinette Hurley

/

Email:

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ICEP Europe,

/

Tel:

/

(UK) + 44 (0)208 354 7592

Unit K4, Maynooth Business Campus,

/ /

(IRL) +353 (0)1 6510618

Maynooth,

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Fax:

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(IRL) +353 (0)1 651007

Co. Kildare,

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Web:

/

(IRL) www.icepe.eu

Ireland.

/ /

(UK) www.icepe.co.uk

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