(Registry Office Use) Surname

/ Part-time Enrolment Form Yr 2016/2017

(Registry Office Use) Surname:

Student Number:

Course code:

Year:

Personal Details
Name
Title / First name(s)
Previous surname
Surname/Family name / If applicable
Sex / Male / Date of birthdd/mm/yy
Female

Company Address

Home Address

Address
Postcode
Telephone number
EMAIL ADDRESS
Type of accommodation occupied during term / Halls of residence/Head Leased property / 1 / Parental/Guardian home / 2
Own home/privately rented house/lodging / 3 / Other / 4

Course of study

Complete part A and/or part B if appropriate. Enter the title of the degree or diploma you are studying in part A and the credit value of all modules being taken this academic year in part B. If you are studying individual modules that do not in themselves lead to a qualification then complete part B only.

Part A

/ Course title / Military Vetronics Architectures – CPD module / Year of course / 1 / 2 / 3 / 4 / 5 / 6
Start date (in this academic year) / 9-10May2017 / Length of course / 2 day - CPD

Part B

/ Module details / Please ensure that you have confirmed which modules you are registered to take this academic year with your school office and note the total value of credits in the box below
Total value of credits / 10 (MSc -Level 7)
Are you attending a PartnerCollege? / Yes / If yes, which college? / N/A
No

Tuition fees

Who is paying your fees? / Self / £
PTDs / Sponsoring Trust:
Sponsor / £ 950 / Sponsored by:
Attach proof of sponsorship – if you do not attach proof or your sponsor does not pay your fees then you will become liable for the full amount due. Proof of sponsorship is required for every academic year. Proof of sponsorship from a sponsoring trust is required if you are being sponsored by Person Training Days (PTDs)

Nationality

Country of residence / Nationality

Ethnic Origin

Please tick one of these codes /

White:

/ Asian or Asian British: / Mixed:
British / 11 / Indian / 31 / White and Black Caribbean / 41
Irish / 12 / Pakistani / 32 / White and Black African / 42
Other / 19 / Bangladeshi / 33 / White and Asian / 43
Black or Black British: / Chinese / 34 / Other / 49
Caribbean / 21 / Other / 39
African / 22
Other / 29 / Other Ethnic background / 80 / Information declined / 98

Disability Please tick one of these codes

None / 0 / Personal care support / 5 / Do you receive a Disabled Students Allowance?
Dyslexia / 1 / Mental health difficulties / 6
Blind/partially sighted / 2 / An unseen disability, eg diabetes, epilepsy or asthma / 7
Deaf/hearing impairment / 3 / Multiple disabilities / 8
Wheelchair user/mobility problems / 4 / Other / 9 / Yes / No

Highest qualifications on entry

Eg. ONC, BEng / Please give details / Qualification / Subject / Grade
Last school/college/institution attended
Have you studied a Higher Education course in the UK before? / Yes
No
Have you completed a recognised access programme? / Yes
No
Are you an exchange student? / Yes / If yes, give the appropriate scheme code
No
Are you a teacher and have Qualified Teacher Status? / Yes / If yes, give DFES number
No / eg R P 9 9 9 9 9 9 9
Are you a nurse? / Yes / If yes, give your NMC reference number
No / eg 9 9 A 9 9 9 9 A

Signature of Student

I understand that the information provided will be recorded in the university’s student record system and will be used for specific academic purposes registered under the Data Protection Act. Some data will be transmitted to the Higher Education Statistics Agency for statistical analysis.

I have understood the information provided regarding the payment of my tuition fees and have completed the Fee Information sheet giving details of who is paying my tuition fees this academic year.

The university will take all reasonable steps to provide the educational services described in the prospectus and other promotional material. In the event of circumstances beyond the control of the university interfering with its ability to provide its educational services, the university will seek to minimise the disruption. I agree to be bound by such University regulations that are in place, or which may be passed during my career at the University.

If returning this electronically, type your name in the signature box with the date, and in doing so, consider this equivalent to your signature.