1

Personal details
Title Male (M) Female (F) Date of birth
Surname/family name
First/given name (s)
Home address
Postcode
Telephone (including STD/area code)
Mobile telephone no
Email address
Postal address (if not home)
Postcode
Telephone (including STD/area code)
Other telephone no
Further details
Area of permanent residence
Country of birth
Nationality Date of first entry to live in UK
Criminal convictions If you have a relevant criminal conviction, enter an X in the box.
See How to Apply for details.
Application Form
App. no For office use only Fee status
Only for applications not handled by a clearing house (UCAS/GTTR/NMAS)
Please read the How to Apply section before completing. Please complete in BLOCK CAPITALS.
Courses applied for (in order of preference)
Mode of study Month & year Stage
Course title (eg. FT/PT/DL/flexible) of entry ie. Year 1
1
2
3
1
2
3
4
Disability/special needs If you have a disability or special needs, enter the relevant code in the box.
See How to Apply for details.
5
D D M M Y Y
D D M M Y Y
Qualifications not yet completed Expected
Level of award
completion date
Subject eg. BA (Hons)
2
School/college and university education (from age 11, starting with the most recent)
From To
Institution PT/FT/SW
Qualifications completed (exams or assessment, etc)
Date
Level eg. GCSE, Result/
A level, grade
Subject BTEC, other
M M Y Y
M M Y Y
M M Y Y
M M Y Y
6
7
8
Date
Level eg. GCSE, Result/
A level, grade
Subject BTEC, other
M M Y Y
3
English language proficiency (international students only)
Was English the language of instruction in your previous institution Yes No Partly
Number of years you have studied in English
I hold the following qualifications
IELTS Score (if known) Date of test Location
TOEFL Score (if known) Date of test Location
Other (please specify)
Score (if known) Date of test Location
If test yet to be completed, please state date to be taken Location
IELTS TOEFL Other
Additional training
Completion date
Subject Organising institution
Employment history
From To
Name of employer/organisation Nature of work PT/FT
9
10
11
M M Y Y
M M Y Y M M Y Y
D D M M Y Y
1. Name in full
Address
Tel
Email
2. Name in full
Address
Tel
Email
4
Personal statement should use a minimum of 250 words (in English)
Names and addresses of two referees
Declaration
I confirm that the information given in this form is correct and complete. I accept that the University has the right to cancel
my application if it is found that I have provided false or inaccurate information. I have read the instructions, in particular
those regarding this section. I understand what they say and I agree to abide by the conditions
set out there, which I accept as a condition of this application.
Applicants signature Date
12
14
13
1
6
1
7
5
6
B
/
1
/
0
6
D D M M Y Y
1 of 4
Notes for Guidance 16/03/06

HOW TO APPLY

Please retain these instructions for your reference. Your application form should be completed in BLOCK CAPITALS
in black ink or type. You should keep a photocopy of your completed application form so you can remember the
information you have included in it, in case you are asked to attend an interview.

THESE INSTRUCTIONS SHOULD BE READ BY ALL APPLICANTS.

Thank you for your interest in Northumbria University. These notes are designed to help you complete your application for
admission to the University. PLEASE ENSURE THAT YOU READ THESE NOTES CAREFULLY. Overseas applicants
should also read the section entitled NOTES FOR APPLICANTS FROM OVERSEAS.

It is important to include all relevant details and documents. This will help us to process your application without any
unnecessary delay. If you fail to provide the information required by the University, or provide false or misleading information,
the University reserves the right to reject or withdraw your application, revise your fees status or cancel your registration.

SECTION 1 PERSONAL DETAILS

Give your title (for example Mr or Miss), your surname or family name and your first or given names. It is important that
the names you give are the same as on official documents such as your passport and qualifications certificates. If you
receive an offer, the University will send you a letter addressing you by the names you provide on your form. Overseas
applicants may find their visa application is delayed if the name on their offer letter does not match the name on their passport.

Give your sex (Male or Female) and your date of birth. This should be in the format:

Day Month Year

Please give your home address. If your home address is not the address where you wish the University to write to you,
please also give a postal address. If you provide a postal address, the University will send any correspondence to this
address. Overseas applicants should note that, for visa purposes, the University will always use your home address in any
offer letter. You may also provide address labels in your own language if necessary for postal reasons.

If you have an email address, please write this down in BLOCK CAPITALS.

SECTION 2 FURTHER DETAILS

The information you provide in this section will be used by the University to determine your fee status. You must
complete this section in full. Failure to complete this section in full may result in you being assessed as an
overseas student for fees purposes.

Area of Permanent Residence: If you live in the UK state your area of permanent residence.
For example, Tyne and Wear, London, Devon
If you live outside the UK state the country (eg Italy) where you are living.
Country of Birth: Must be entered by all applicants
Nationality: Must be entered by all applicants

SECTION 3 COURSES APPLIED FOR

Please specify in order of preference the courses for which you wish to be considered. Applicants from overseas who wish to
apply for a preparatory English programme should also list this here.

SECTION 4 CRIMINAL CONVICTIONS

The University has a duty of care to its students and staff, and to help reduce the risk of harm or injury to them caused by the
criminal behaviour of other students, the University must know about any relevant criminal convictions that an applicant may
have.

Relevant criminal convictions are only those convictions for offences against the person, whether of a violent or sexual nature,
and convictions for offences involving unlawfully supplying controlled drugs or substances where the conviction concerns
commercial drug dealing or trafficking. Convictions that are spent (as defined by the Rehabilitation of Offenders Act 1974) are
not considered to be relevant and you should not reveal them (but see the next paragraph below).
If you are applying for courses in teaching, health, social work and courses involving work with children or vulnerable adults,
you MUST tell us about any criminal convictions, including spent sentences and cautions (including verbal cautions) and bind
over orders. For these courses, you may need an enhanced disclosure document from the Criminal Records Bureau (CRB)
and the University will send you the appropriate documentation to complete. Further details about the CRB and its work can
be found at www.crb.gov.uk.
2 of 4
Notes for Guidance 16/03/06


Courses in teaching, health, social work and courses
involving work with children or vulnerable adults
All other courses
For these courses, you must enter X in the box if either of the
following statements apply to you:

a. I have a criminal conviction
b. I have a spent criminal conviction
c. I have a caution (including a verbal caution)
d. I have a bind-over order
e. I am serving a prison sentence for a criminal conviction.

If statement e. applies to you then you must also give the
prison address as your postal address on page 1 of your
application and a senior prison officer must support your
application.
For these courses, you must enter X in the box if either of the
following statements apply to you:

a. I have a relevant criminal conviction that is not spent
b. I am serving a prison sentence for a relevant criminal
conviction.

If statement b applies to you then you must also give the
prison address as your postal address on page 1 of your
application and a senior prison officer must support your
application.

Convictions that are spent (as defined by the Rehabilitation of
Offenders Act 1974) are not considered to be relevant and you
should not reveal them

Applicants who enter X in the box will not be automatically excluded from the application process. However the university may
want to consider your application further or ask for more information before making a decision.

If you are convicted of a relevant criminal offence after you have applied, you must inform the university immediately
by contacting Admissions in writing. Your letter should be marked private and confidential for the attention of the
Admissions Officer. Do not send details of the offence; simply inform the university that you have a relevant criminal
conviction. You may then be asked to supply more details.

SECTION 5 DISABILTY/SPECIAL NEEDS

Applications are welcome from students with disabilities. If you have a disability, special need (including dyslexia or other
specific learning difficulty) or a medical condition, please select the most appropriate code from the list on this page and enter
it in the box. If you do not have a disability, special need or medical condition, then please use code 0. If you do not want to
give this information now, leave the box blank. If you would like to speak to a member of staff in confidence about your
disability, then please contact the Disability Adviser on 0191 227 3385.

Disability, special needs or medical condition codes
0 None 6 You have mental health difficulties
1 You have a specific learning difficulty (for example dyslexia) 7 You have a disability that cannot be seen for
2 You are blind or partially sighted example diabetes, epilepsy, or a heart condition
3 You are deaf or hard of hearing 8 You have two or more of the above
4 You use a wheelchair or have mobility difficulties 9 You have a disability, special need or medical
T You have Autistic Spectrum Disorder or Asperger Syndrome condition that is not listed above.

SECTION 6 SCHOOL/COLLEGE AND UNIVERSITY EDUCATION

Give the names and brief addresses of the three most recent educational establishments you have attended, including the
current one if appropriate. List the most recent one first.

SECTION 7 QUALIFICATIONS COMPLETED

It is important that the details in this section are completed correctly. You should include all qualifications for which you have
received an award. If you do not have enough space, then please continue on a separate sheet clearly marked with your full
name, date of birth and the course for which you are making application.

SECTION 8 QUALIFICATIONS NOT YET COMPLETED

You should list all of the qualifications you are studying for now and all those for which you are awaiting results.

SECTION 9 ENGLISH LANGUAGE PROFICIENCY

THIS SECTION SHOULD BE COMPLETED ONLY BY THOSE APPLICANTS WHOSE FIRST LANGUAGE IS NOT
ENGLISH.

If English was the language of instruction in any of your academic studies, please give full details of the number of years you
have studied in English and at which institution(s). If you have already sat an English test, such as IELTS or TOEFL, then you
should indicate your score in the box provided. If you have yet to sit a test, you should indicate when you will sit the test and
when you expect to receive your results.
3 of 4
Notes for Guidance 16/03/06

SECTION 10 ADDITIONAL TRAINING

Please include details of any additional training you may have undertaken. This can include work based training.

SECTION 11 EMPLOYMENT HISTORY

Please give the names and addresses of your most recent employers (if any) and briefly describe your work. If you wish, you
may attach a CV/resume or summary describing in more detail the nature of the work undertaken, positions held and
responsibilities.

SECTION 12 PERSONAL STATEMENT

This section is for any other information you would like to be taken into account in support of your application. This could
include your reasons for your choice of course; career aspirations and any achievements/experiences you feel would be
relevant. Include social, sporting and other interests. If you lack relevant formal qualifications, use this space to outline any
relevant experiences that may be taken into account. Also, if you are applying for deferred entry, please state your reasons.

SECTION 13 REFEREES

This section also contains space for you to include the names and contact details for two referees. Please supply a reference
from one of them, using the supplementary reference form provided, and submit with your completed application form. If
required, the admissions team can approach your other referee for an additional reference. Your referee should be someone
who has taught you or knows you in a professional capacity. Friends, family members, or representatives (agents) cannot be
given as referees.

SECTION 14 DECLARATION

You must sign this yourself. Any offer of a place you may receive is made on the understanding that in accepting it you agree
to abide by the rules and regulations of the University and by signing this form you are confirming your agreement to this.

IMPORTANT NOTE

The University undertakes to take all reasonable steps to provide educational services in the manner set out in the prospectus
and in other documents. Should industrial action or other circumstances beyond the control of the University interfere with its
ability to provide such services, the University undertakes to use all reasonable steps to minimise the resultant disruption to
educational services. The University does not undertake any absolute obligation whatsoever to provide educational services
in the manner specified in the prospectus or in any other document, nor does it undertake any other obligation in respect of
the provision of educational services which is more onerous than the obligations set out herein.

Should you become a student of the University, this notice shall be a term of any contract between you and the University.
Any offer of a place made to you by the University is made on the basis that in accepting such an offer you signify your
consent to the incorporation of this notice as a term of any such contract.

THE DATA PROTECTION ACT 1998

The information that you give on your application form will be used for the following purposes only:

1. To enable your application for admission to be considered.
2. To enable the University to compile statistics, or to assist other organisations or individual research workers to do so,
provided that no statistical information which would identify you as a person will be published.
3. To enable the University to initiate your student record.

WHAT HAPPENS NEXT

Please send your form to:

Admissions
Northumbria University
Trinity Building
Northumberland Road
Newcastle upon Tyne
NE1 8ST

The University will send you an acknowledgement to tell you that your application has been received and will provide you with
an application number. Please record that number here: / . You should quote this
number in all your dealings with the University. Good luck with your application.

4 of 4
Notes for Guidance 16/03/06

NOTES FOR APPLICANTS FROM OVERSEAS

You should read the instructions above carefully. In addition, you should also note the following important points:

You must complete the application form yourself and in English. You should complete all sections as fully as
possible. If you miss out any important information, the University may not be able to process your form and your
application will be delayed.

Please write in block capitals and black ink. If University staff cannot read your application, then this may lead to
mistakes being made in your offer letter and your visa application being delayed.

You should include copies of your academic qualifications/transcripts with your application form. These MUST be in
ENGLISH. If the originals of these documents are in your own language, then you must include a certified
translation.

You should apply for your course in good time. You will need to apply for a visa and make all of the necessary
preparations to study in the UK. The University reserves the right to refuse to process application forms from those
applicants who wish to begin a course in September whose form is received after the end of J uly of the year of
application. In these circumstances, your application will be considered for the next available intake. Applicants who
wish to apply for a course that begins in J anuary/February should aim to send their application form so it arrives at
the University before the end of November.

You should also remember to tell us if you have a relevant criminal conviction (see section 5 above).

If you have any disabilities, special needs or medical condition please tell us about these by completing the relevant
box. This will help us to determine if you will need any special facilities or support. If you do not have a special need,
then please use code 0.

If you intend to apply for any art or design course or the BA (Hons) in Architectural Design and Management, the BSc
(Hons) in Product Design and Technology, or the BSc (Hons) in Computer Aided Product Design you MUST include
at least 15 different samples of your own artwork with your application, preferably in CD ROM format or as 35mm
slides or colour prints. Artwork supplied should reflect the range of your creative ability.

You may find it useful to complete the following checklist to make sure you have completed all parts of the form and have
included all relevant supporting documentation

Application Checklist for Overseas Applicants

The Application Form

I have completed all sections of the form

I have signed the form

Documents Attached

Copies of academic certificates

Transcripts of results in each subject

English language examination results

References

Artwork (if applicable)

If you are making an application through an agent, please send your form to the following address:

International Office
Northumbria University
21/22 Ellison Place
Newcastle upon Tyne
NE1 8ST
UNITED KINGDOM

Fax: 0044 191 261 1264

Application Form: The Reference
Solely for use for applications not handled by the University and
Colleges Admissions Service (UCAS) or other clearing houses
This separate reference form is available for applicants who need to provide more than one reference. See Notes for Guidance
Condential statement by referee (to be completed by all applicants)
Applicants full name
Date of birth
1st choice of course (see prospectus for ofcial title)
Alternative choice of course
Part C
Reference Number
(for university use)
NOTES for the Guidance of Referees
Please ensure that the form is completed in black ink and, if typed, that a good ribbon is used. If possible check that the
applicant has completed the form correctly and legibly.
The referees report is an integral and important part of the selection process, and the information you give will help to guide
admissions tutors in making their decisions.
In order that institutions can evaluate an applicants academic and intellectual capacity, your reference should if possible
cover:
Mature Applicants
Referees may have difculty in commenting on the academic abilities of mature applicants who may not have any recent
educational experience, and in these circumstances, referees may wish to conne their comments to matters listed under
1, 2c, 3, 4, 5 and 6 above
Please return to: Admissions
Northumbria University
Trinity Building
Northumberland Road
Newcastle upon Tyne
NE1 8ST
1. Suitability for the course(s) applied for.
2. Intellectual qualities including:
(a) development to date and previous examination
performance with special reference to any factors
which may in your opinion have adversely inuenced
the result;
(b) present performance;
(c) potential, including an assessment of the probable
results of pending examinations; if applicable.
3. Personal qualities.
4. Career aspirations.
5. Health and other personal circumstances relevant to
the application.
6. Athletic, social and other interests.
Part C
Condential statement by referee
Name of referee
Post/occupation/relationship
Address
Telephone No. (including STD) Fax No. (including STD)
This form may be photocopied: please type with a good black ribbon or write in black ink within the frame. Typing is very much preferred.
Please afx ofcial stamp where appropriate, at the end of the statement.
Name of applicant (block capitals or type)
Section 6 checked
as correct (if
applicable)
Signed
Date
YES/NO
ER-63137-3/03
1 of 1
Notes for Guidance 16/03/06

If you are using Part C to request a reference please enter your name and programme choice on the form.

Normally, your referee would be one of the following: The Head of your present or last school; Principal or Programme tutor of
your present or last programme of studies. If you have been out of education for some time, you may wish to consider one of
the following; your current or last employer: or training officer, or careers advisor; an officer of any relevant organisation you
belong to (voluntary or not). If you have any difficulty in identifying a suitable referee you should seek the advice of the
programme to which you are applying.

You may need to submit two references or you need to submit your application form and send the reference form
to your referee who can then send the completed reference separately. The University may contact your
referee(s) directly after receipt of your application.

NOTES FOR THE GUIDANCE OF REFEREES

The reference may be photocopied therefore please ensure that the form is completed in black ink and/or typed. If
possible check that the applicant has completed the form correctly and legibly

The referee's report is an integral and important part of the selection process, and the information you give will help to guide
admissions tutors in making their decisions.

In order that the University can evaluate an applicants academic and intellectual capacity, your reference should if possible
cover:

1 Suitability for the programme(s) applied for.
2 Intellectual qualities including:
a) development to date and previous examination performance with reference to any factors which may in your opinion
have adversely influenced the result including, if relevant, a verification of the examinations detailed in Section 6.
b) present performance.
c) potential, including an assessment of the probable results of any pending examinations.
3 Personal qualities.
4 Career aspirations.
5 Health and other personal circumstances relevant to the application.
6 Athletic, social and other interests.