Application Form

Please complete the below form and return to

[email protected]
If completing the form by hand, please print clearly
in black ink and BLOCK CAPITALS

1. Personal Details.

Family name as appears in passport VU

First name(s) as appears in passport THUY DUONG

MISS
Title (Mr/Mrs/Miss/etc) Previous family name (if applicable)
0 9 - 0 1
Date of birth - 0 3 Male Female Other

Home/permanent Correspondence address or

address address of University Representative (if different)
International Education Service Pte Ltd (Singapore)
2nd Floor, Hoa Phat Building, 257 Giai Phong St., Dong Da Dist., Hanoi

VIET NAM

Postcode Postcode 10000

VIETNAM
Country Country Vietnam

Tel no. Tel no.

Mobile Mobile +84 981 936 173

[email protected]
Email Email [email protected]

Nationality (if dual please give both) Country of birth

VIETNAMESE VIETNAM
Country of permanent residence (if UK give County/Borough) Entry date to UK
VIETNAM - -

2. Course(s) applied for.

First choice SEPTEMBE

Start date Month Year 2023

Point of entry (i.e. year 1, 2 or 3) YEAR 3

Mode of Study Full-time Part-time Distance

Level of Study Undergraduate Postgraduate (taught) Research

Second choice Start date Month Year

Point of entry (i.e. year 1, 2 or 3)

Mode of Study Full-time Part-time Distance

Level of Study Undergraduate Postgraduate (taught) Research

3. Previous and present education.
Please list details of all institutions attended since age 11.

Name and address of institution From (mm/yy) To (mm/yy) Study mode PT/FT/DL*
LE QUY DON SECONDARY SCHOOL 9/20130 05/2017
Full-time

LAO CAI HIGHSCHOOL FOR GIFTED STUDENTS 09/2017 05/2020

M9 STREET, BAC CUONG WARD, LAOCAI CITY, Full-time
VIETNAM
FOREIGN TRADE UNIVERSITY 09/2020 04/2023
91 CHUA LANG, DONG DA DISTRICT, HANOI CITY, Full-time
VIETNAM

Select

*PT = part-time, FT = full-time, DL = distance learning

4. Academic qualifications - examinations achieved.

Please list all qualifications taken, whatever the result, in chronological order. Documentary evidence of known results
should be sent with this form. Only certified photocopies are acceptable.

From (mm/yy) Awarding body Subject Qualification Results achieved

5. Academic qualifications - examinations pending.

Complete this section only if you are awaiting the result of any examination taken recently.

Exam date (mm/yy) Awarding body Subject Qualification

6. Previous study in the UK (for overseas (non-EU) applicants).
The Home Office has introduced a limit to the time that international students on a Tier 4 Student Visa can spend
studying at degree level. There will be a general limit of 5 years on study time but this will not apply to those studying
for Master’s degrees following successful completion of an undergraduate degree where the undergraduate course
duration was 4 or 5 years. In these cases the limit will be set at 6 years. We also have to ensure that any study you are
proposing to undertake represents academic progression from any previous studies in the UK.

In view of this new policy it is essential that you answer the following question:

Have you ever studied previously in the UK? Yes No

If yes, please list below any previous study (regardless of the level i.e. English language courses) undertaken in the UK.
We will also require copies of all visas held during those periods of study.

Institution Course studies and level Start and completion of Type of visa held during
i.e. foundation/degree etc course period of study

If you have previously been a student at the University of Northampton please give your student ID number.

Do you require a Tier 4 visa to study with us? Yes No If no please provide us with a copy
of your current visa.

7. English language.
All international students applying for a course at the University of Northampton must meet the minimum English
language requirements, however, if you do not meet these requirements we offer pre-sessional academic English
language courses and an international foundation programme.

For more information visit: www.northampton.ac.uk/study/international-students/english-language-requirements

Please give full details, including dates, of any English tests taken/to be taken:
Level Where studied University/College/Awarding body Date taken (mm/yy) Results
B2 VIETNAM IELTS
8. Work experience. (if applicable to course application)
Please give details of work experience, training and employment.

Dates from Dates to FT/PT* Post held Organisation name and address Brief description of
(mm/yy) (mm/yy) duties

Select

Select

Select

Select

* FT = full-time, PT = part-time

9. Finance and fee status.

All students offered registration will be asked to supply details of their financial position, letters of guarantee from
sponsors etc, to ensure that they can complete the course without financial hardship.

Who will be paying your fees?

Self Sponsor

Student Finance England

Employer Please give details

Please give details of any scholarship grant application giving name, value and duration.

Already awarded Please give details

Application made Please give details

10. Declaration of a criminal conviction.

Only complete this section if you are applying for a course that requires a Disclosure and Barring Service (DBS)
check, which can be confirmed by checking the course entry requirements on our website.

Please indicate if you have a relevant criminal conviction by ticking in the box Yes No

Applicants who answer ‘Yes’ will not be automatically excluded from the application process, and their application
will be considered on its merits before the relevance of their criminal conviction is taken into account. However, the
University may ask for more information about their criminal conviction before making a final decision.

If you are convicted of a relevant criminal offence after you have applied, you must tell us. Do not send details of the
offence; simply tell us that you have a relevant criminal conviction. The University may then ask you for more details.
11. Personal statement/further information.
Please use this section to tell us about yourself and your reasons for wanting to study this course.
Please continue on a separate sheet if necessary.
12. References.
Please read the guidance notes carefully. Please note that it is your responsibility to send Part B – Statement by
Referee - to your referees for completion. We will not be able to make a decision about your application until we
receive your references, one of which must be an academic reference if you have recently completed a school or
university course.

Referee 1 - Academic Referee 2

Name Name

Address Address
91 Chua Lang Street

Postcode Postcode

Tel No. Tel No.

Fax No. Fax No.

Email Email

Capacity in which applicant is known to the referee Capacity in which applicant is known to the referee

For how long For how long

Please note, references should not be provided by close family members or friends.

13. Disabilities/special needs.

Please tick the appropriate box(es) and in the space at the bottom of this section indicate any additional support
or facilities that you may need at the University. This information will be made available to ASSIST who can support
applicants through the admissions process and agree adjustments for their studies. Information you disclose about
your disability will be used in accordance with the University’s Admissions Policy.
You can access this at www.northampton.ac.uk/more/governance-and-management/university-policies-
procedures-and-regulations and find information about Disability Services at www.northampton.ac.uk/study/
student-life/support

No known disability Autistic Spectrum Disorder/Asperger’s Syndrome

Blind or a serious visual impairment Long standing illness or health condition

Deaf or a serious hearing impairment Mental health condition

Two or more impairments and/or Wheelchair user/mobility difficulties

disabling medical conditions

Specific Learning Difficulty (eg Dyslexia) Other disability not listed above

I am in receipt of the Disabled Students’ Allowance Yes No

I am applying for or intend to apply for the Disabled Students’ Allowance Yes No

Please detail below any additional support, adjustments or changes you may need for your studies
How did you hear of the University of Northampton? From an agent

Declaration.
By providing this information you acknowledge that the University will need to process such Personal Data to enable
the review of your application. To allow for the lawful processing of your personal data, we need your consent. Please
sign to confirm that you agree to such processing and to allow us to consider your application.

As an international applicant the processing of your data will include the University sharing your Personal Data
and special category Personal Data with UK Visas and Immigration (UKVI), which will enable them to confirm your
immigration history. Such sharing is a legal requirement.

You also acknowledge that should you not meet the entry requirements of your chosen course at the University,
you consent to the University sharing your Personal Data and special category Personal Data with our partner
college, University of Northampton International College (UNIC) in order for you to be considered for an alternative
programme of study at UNIC.

In completing and submitting your application form, you will be providing the University of Northampton with
personal data, including special category data, as defined in the Data Protection Act 2018 and the General Data
Protection Regulation (GDPR) ( (EU) 2016/679). The University will use this data for processing your application and it
may be shared with several departments within the University. The University policy on Data Protection and GDPR
compliance can be found at: www.northampton.ac.uk/about-us/services-and-facilities/records-management/data-
protection-act

And for more detail on how the University processes personal data please see our Privacy statements at:
www.northampton.ac.uk/about-us/privacy-policy

This personal data may also be shared with and used by third parties in connection with the above purposes, for
example in order to verify your identity, qualifications, work experience and other information that you provide, or
so that the University can comply with its obligations to supply certain information to the Higher Education Statistics
Agency, Department of Education, UKVI and other agencies. In certain circumstances including the prevention and
detection of crime, details may be provided to the Police or other relevant lawful authority. Such processing is lawful
under the terms of GDPR Article 6 and Article 9.

Some of these third parties may be located outside the European Economic Area but the University will where
possible ensure that they abide by the relevant UK legislation.

I declare that I understand the statement regarding the use by the University of my personal data. I further declare
that the information on this form is correct to the best of my knowledge. I understand that if I have been found to
have deliberately and seriously misled the University about the details on this form I could be asked to withdraw from
my course.

Signed Date

Please return completed applications to:

International Office, University of Northampton, Newton Building, St George’s Avenue, Northampton, NN2 6JB, UK
or email to: [email protected].
 Part B - Statement by referee.

To be completed by applicant.

Applicant’s full name

Course (see website for title: northampton.ac.uk)

- -
Date of birth Male Female Other

Name and address to which reference is to be sent (i.e. your address)

Postcode Country

Email

Notes for the guidance of referees

A referee must be able to comment on academic ability and must not be related to the applicant. The reference
should include the following:

How long and in what capacity has the referee known the applicant?
How do you assess the applicant’s academic/intellectual ability? (It would be helpful if, in the case of a graduate,
referees could indicate whether they consider the class of degree achieved fairly represented his/her calibre).
What are the strengths/weaknesses of the applicant?
Any further relevant information.
To be completed by the referee.

This form may be photocopied: please type if possible, or write in black ink. Please affix an official stamp, where
appropriate, at the end of the statement

Name of referee

Post/Occupation/Relationship

How long have you known applicant

Name of School/College/Organisation

Address

Postcode Country

Tel No. Fax No.

Email

Name of applicant (block capitals or type)

Signed Date
 Part B - Statement by referee.

To be completed by applicant.

Applicant’s full name

Course (see website for title: northampton.ac.uk)

- -
Date of birth Male Female Other

Name and address to which reference is to be sent (i.e. your address)

Postcode Country

Email

Notes for the guidance of referees

A referee must be able to comment on academic ability and must not be related to the applicant. The reference
should include the following:

How long and in what capacity has the referee known the applicant?
How do you assess the applicant’s academic/intellectual ability? (It would be helpful if, in the case of a graduate,
referees could indicate whether they consider the class of degree achieved fairly represented his/her calibre).
What are the strengths/weaknesses of the applicant?
Any further relevant information.
To be completed by the referee.

This form may be photocopied: please type if possible, or write in black ink. Please affix an official stamp, where
appropriate, at the end of the statement

Name of referee

Post/Occupation/Relationship

How long have you known applicant

Name of School/College/Organisation

Address

Postcode Country

Tel No. Fax No.

Email

Name of applicant (block capitals or type)

Signed Date
Equal opportunities monitoring form

In order to monitor equality of opportunity in the admission of students to the University of Northampton, applicants
are asked to describe their ethnic origin in one of the categories below. Your response will not influence the outcome
of your application. You do not have to answer this question if you do not wish.

A White B Mixed

British11 White and Black Caribbean 41

Irish12 White and Black African 42

Any other White background, please detail 19 White and Asian 43

Any other Mixed background, please detail 49

B Black or Black British E Chinese or other ethnic group

Caribbean21 Chinese 34

African22 Any other Chinese background, please detail 80

Any other Black background, please detail 29

C Asian or Asian British F Information refused

Indian31  98

Pakistani32

Bangladeshi33

Any other Asian background, please detail 39

I indicated on my application that I have a disability. Yes No