Application for Taught Postgraduate Study

Please refer to the guidance notes when completing this form

1 Your personal details

a) Title (eg Mr, Mrs, Miss, Ms, Dr) b) Gender j) Permanent home address
male female

c) Family name (see note 1c)

d) First names

e) Previous family name (if you have changed it – eg through marriage) k) Home telephone no (with code) l) Home fax no (with code)

f) Date of birth g) Nationality (see note 1g) m)Correspondence address if different from above.
Please give the dates when you will be at this address (see note 1m)
/ /
h) Daytime / work telephone no (with code)

i) Email

2 Taught programme of study

a) Programme (see note 2a) d) Start date
/ /
e) Mode of study (see note 2e)

b) Faculty full-time part-time part-time by distance learning

f) Are you seeking exemption

from part of the programme
on the basis of AP(E)L? yes no
(see note 2f)
c) Qualification aim (see note 2c)

University use only Application no:

For completion by Faculty / Department

Decision: Signature:authorised selector (1)   
date
unconditional offer conditional offer reject

Conditions: Signature:authorised selector (2)

date

Other Faculty / Department use

Programme, qualification aim, start date and study mode if other than indicated
by applicant in Section 2 above:
For completion by Registry
Date application received Date application returned

Bench fees p.a. Fees status Initials

date
£ 1 2 3 4 query
3 Further and Higher Education qualifications (see note 3)

university / institution subject start date end date qualification aimed for
current education

university / institution subject start date end date qualification obtained class/result
previous education

4 Professional qualifications (see note 4)

title / category of membership date attained mode

5 English Language qualifications (see note 5)

To be completed by all candidates whose first language is not English

title of English Language test / course examining body date to be taken date taken grade obtained
current

previous

6 Employment history (see note 6)

name & location of employer job title start date end date full/part-time / temporary
current

previous
7 Finance and fees status (see note 7)
a) Proposed source of fees c) Status of sponsorship application
If you have made an application for sponsorship, give details of
sponsor(s) approached and the outcome or current status of your
application.
b) Proposed source of living expenses

In order for us to determine your fee status, please answer the following:

Have you lived in the UK / EC / EEA all your life?

no yes “ if ‘yes’, which country(ies)? Now go to section 8
“

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Have you lived outside the UK / EC / EEA all your life?

no yes “ if ‘yes’, which country(ies)? Now go to section 8

If you have answered ‘no’ to both the above questions please provide full details of your residence in a separate sheet.
“

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Are you a UK or EC national, or the child of an EC national?

yes no “ if ‘no’, but you have the right to live in the UK without restriction or you have applied for refugee status,
you should enclose documentary evidence

8 Additional personal information

a) Please enter the appropriate disability code from section 8a of the guidance notes.
If you do not have a disability, please enter 0

b) Please tell us how you found out about the programme of study for which you are applying

c) Do you have any relevant criminal convictions or charges against you? no yes
please refer to note 8c

d) Are you applying for any other courses at the University of Surrey or elsewhere? no yes “ please give details below

9 Personal statement this is optional (see note 9)

 10 Ethnic Origin

orship, give details of

The University of Surrey confirms its commitment to
or current status of your a comprehensive policy of equal opportunities for its
applicants and students. Individuals are selected and
treated on the basis of their relevant merits and abilities
and are given equal opportunities within the University.
The aim of the policy is to ensure that no applicant should
receive less favourable treatment on any grounds which
are not relevant to academic ability and attainment for
students. The University also has a race equality policy to
complement the equal opportunities policy.
go to section 8 The information that you provide in this section of the
form is extremely important as it enables us to assess the
effectiveness of our EO policies (above) to ensure that
the recruitment and selection process operating across
the University is open and fair. Through assessing the
go to section 8
effectiveness of the process we aim to ensure that your
experience of the University of Surrey is a positive one.
eet.
The information you provide will form a confidential record
and will be stored electronically and manually. It will only
be used to monitor the operation of EO policies and will
not be passed to those making admission decisions.
efugee status,
Please tick the code from the table below which most
closely describes your ethnic origin:

Details Code

White – British 11

White – Irish 12

Other White Background 19

Black/Black British – Caribbean 21

Black/Black British – African 22

please give details below Other Black Background 29

Asian/Asian British – Indian 31

Asian/Asian British – Pakistani 32

Asian/Asian British – Bangladeshi 33

Chinese 34

Other Asian Background 39

Mixed – White & Black Caribbean 41

Mixed – White & Black African 42

Mixed – White & Asian 43

Other Mixed Background 49

Other Ethnic Background 80

Not Known 90

Information Refused 98
11 References (see note 10)

Please fill in contact details for two people who can provide a reference for you about your
academic ability and / or work experience in relation to your proposed study. At least one of the
referees must be able to comment on your academic ability in relation to your proposed study.
Referee 1:
a) Name and title g) Address

b) Organisation

c) Position

d) Telephone no (with code) e) Fax no (with code)

f) Email

Referee 2:
a) Name and title g) Address

b) Organisation

c) Position

d) Telephone no (with code) e) Fax no (with code)

f) Email

12 Declaration
Signature
Please ensure that you read the declaration below and sign and
date the form.

I confirm that the information I have given is correct and that

no material information has been omitted. I understand that
the University reserves the right to withdraw any offer or Date
cancel a registration made on the basis of information which / /
proves to be false or misleading.

What to do now
Please tick as appropriate to indicate the additional This form should then be returned to: Postgraduate Admissions Office
information you are supplying with this application form: The Registry
University of Surrey
I enclose: Guildford
Surrey GU2 7XH
Copies of transcripts and / or examination certificates United Kingdom

English Language Proficiency Certificate(s) if applicable

(see note 5)
Evidence of right to live in the UK with no restrictions or of
refugee status application if applicable (see note 7)
Information about any disability, special need or medical
condition if applicable (see note 8a)

Information about any criminal offence (see note 8c)