Undergraduate Advanced Diploma in Data and Systems Analysis
Application Form
Before completing this form we recommend that you read the section ‘How to apply’ which provides guidance on some of the questions. Please note that the fields marked with an asterisk(*) are compulsory.
All names, in full, as they appear on you birth certificate/passport:
Surname*:
First Name*:
Title:
Preferred name:
Date of Birth*:
Day:
Month:
Year:
Male / Female:
Nationality:
Occupation:
Home Address (including postcode/ zip code)*:
Home Tel*:
Mobile Tel:
email*:
Previous Educational Qualifications
Please list below ALLyour educational qualifications, from the UK or elsewhere, giving awarding body,subject, grades and dates received:
Are you currently studying for another qualification, or do you intend to study on another course in 2015-16?
Yes/No
If you are, please give dates and further details below:
Reasons
What are your reasons for wanting to do this course? Please refer to 'How to apply' and answer in at least 250 words:
Computing Experience
Please describe in at least 250 words your current competence in computing.
Please refer to 'How to apply' before completing this section. Please list any training courses in computing that you have completed, giving course title, duration, course provider and dates:
Your System
Please give details of the computer system you will be undertaking the course from:
Make:
Model:
Speed:
Referees
Please give the names of two referees and explain how they are known to you:
Referee 1*:
Referee 2*:
How did you first discover this course? *
Word of mouth – Yes/No
Internet/World Wide Web – Yes/No
Which website did you discover the course on?
Advertisement (please name publication) – Yes/No
Leaflet in library or record office – Yes / No
Leaflet in magazine (please name publication) - Yes/No
Other (please specify)
English Language Requirements
Is English your first language?
Yes/No
If not, please refer to the section on 'English language requirements' and state what English language qualifications you have.
Fees & Fee Status
Would you be paying all or most of the fee for this course yourself?
Yes/No
If no, please state main source of funding (e.g. employer):
Permanent address (if different to address previously given):
Postcode:
Are you permanently resident in the United Kingdom or in a country in the European Union?
Yes / No
Previous Courses with Oxford University Department for Continuing Education
In previous years have you attended and taken part in the assessment for any other certificate, diploma or accredited course of this Department?
Yes/No
If yes, please give details below (including name of course and year):
The Higher Education Statistics Agency (HESA) uses some of the information on this form for statistical analysis as a condition of funding for the University. HESA is registered under the Data Protection Act. The personal information you give will not affect your application, and will only be sent to HESA if your application is successful.
Ethnicity
Please delete those that do not apply.
10 White
15 Gypsy or Traveller
21 Black or Black British - Caribbean
22 Black African
29 Other Black background
31 Asian Indian
32 Asian Pakistani
33 Asian Bangladeshi
34 Chinese
39 Asian other
41 Mixed - White & Black Caribbean
42 Mixed - White & Black African
43 Mixed - White & Asian
49 Other Mixed background
50 Arab
80 Other Ethnic background
90 Not known
98 Information refused
Disability
Please delete those that do not apply.
None
Blind/partially sighted
Deaf/hearing impairment
Wheelchair user/mobility difficulties
Personal care support
Mental health difficulties
An unseen disability, e.g. diabetes, epilepsy, asthma
Two or more impairments and/or disabling medical conditions
Autistic Spectrum Disorder
A specific learning difficulty e.g. dyslexia
A specific learning difficulty such as dyslexia, dyspraxia or AD(H)D
A social/communication impairment such as Asperger's syndrome/other autistic spectrum disorder
A long standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease, or epilepsy
A mental health condition, such as depression, schizophrenia or anxiety disorder
A physical impairment or mobility issues, such as difficulty using arms or using a wheelchair or crutches
Deaf or a serious hearing impairment
Blind or a serious visual impairment uncorrected by glasses
A disability, impairment or medical condition that is not listed above
Information refused
Information not sought
Not known
Other, please state:
Special Need or Support
Please describe any special need or support which would help you with your study. Even if you do not consider that you have a disability, please feel free to ask for assistance.
Other Information
Any other information you would like us to know:
If you would like to receive information on future courses offered by Oxford University Department for Continuing Education please indicate here:
Yes/No
To proceed to make an application, please check through the details that you have entered. Receipt of your application will be acknowledged by email. Read the statement below, and if you agree, email your completed form as an attachment to to submit your application. Please note that for this course all applications must be submitted by email.
Agreement
I certify that to the best of my knowledge the information provided on this form is correct. I understand that, if I am accepted for this course, I will be required to pay a non-refundable deposit of £250 or 10%, whichever is the greater, towards the overall fee at the time of acceptance and the balance in instalments.