International Student
Application Form

Please return the completed form to:
International Admissions

University of Bedfordshire
University Square, Luton, Bedfordshire LU1 3JU United Kingdom
T: +44 (0)1582 489326
5JFS

Sponsor F: +44 (0)1582 743469
Licence Number DA8AR2CH7 [email protected]

Please read the notes at the back before completing this form. It is important that you write neatly using BLOCK
CAPITALS in black ink or typescript. If available, you must include a copy of the personal details page from your
passport (the page that contains the passport number and your photo). Incomplete application forms submitted
without ALL the supporting documents may delay the issuing of your offer.

1 Personal Details
Title (Mr/Mrs/Miss/Ms etc) Male Female Date of birth* (dd/mm/yyyy) 31/12/1997
First name(s)
Mohamed
Family name(s) Diallo
Previous family name (if changed)

Passport number and country of issue B00093188 Mauritania

Correspondence address Sousse/ Tunisia Permanent/Home address (if different) Nouakchott/ Mauritania

Postcode Postcode
4050 0000
Telephone (including international code) Telephone (including international code)
+21651769355 +22249701933
Mobile (including international code) Mobile (including international code)
+21620116392
Current email Skype ID Mohamed Diallo
[email protected]
Do you have any criminal convictions? Yes No
Have you received any other penalty in relation to a criminal offence; for example a caution, reprimand, warning, or similar penalties in
the UK or any other country? Yes No

2 Fee Status and i ration History

Country of birth
Mauritania Present nationality Mauritanian
Country of Domicile Mauritania

Are you currently a resident in the UK? Yes No Have you ever been refused a Visa to any country? Yes No
Have you studied in the UK previously? If es o Have you been denied entry to the UK before? Yes o
yes, provide details below.
Have you ever overstayed any type of UK Visa
granted to you? Yes o

UK Visa Number Visa Type Valid From Valid To Institution

JTV6VB659 Tier 4 Student 15.08.2010 31.11.2011 University of Oxford
EXAMPLE EXAMPLE EXAMPLE EXAMPLE

www.beds.ac.uk/international April 2018

 3 Agent Details (to be completed if applying through an Agent)
Agent (Code) Email
Contact name Telephone (including international code)
Agent address

Country Postcode

4 Details of Course(s) for which you wish to Apply

If you require UG
Course title Undergraduate (UG) Advanced Level Entry –
or please state Level 2 or 3 Month/year
Postgraduate (PG)? (complete Section 4a) of entry
Choice 1: Accounting and Business finance with Data Analytics MBA PG 09/2023
Choice 2: MBA (Hospital and Health Services Management) with Data Analytics PG 09/2023
Choice 3: UG 09/2023
Adult Nursing BSC
4a To be Completed for Entry on to Degree Level 2 or 3
Please include a transcript (detailed mark certificate) of all units of learning successfully studied, as well as detailed information
which clearly states what curriculum was covered in each unit of learning. To confirm the units for your University of Bedfordshire
programme, please check the relevant course page on our website: www.beds.ac.uk
Please tick which of the following you are including as evidence to support your claim (claims will not be considered without the
required evidence):
official certificates and transcripts unit outcomes/objectives assessed coursework/project work
unit descriptor unit syllabus marked examination papers

5 Full Academic History and Qualifications

Please list results, including those which are pending. Please attach photocopies of your certificate, transcripts, copies of all UK
Visas, copies of previous CAS', enrollment letters, and student status letters. You must give details of every institution at which
you have studied even if you did not receive an award from that institution.

Name of ro ra NQF Start Date End Date o you a a

institution o tudy Level i of Course of Course urtail nt l tt r
studi d is is a l tt r
ro t to
in t say t at you a If yes
an isa iry please provide
dat If yes please
copy of letter
provide copy of
letter

University of
Foundation 3 15.01.2012 20.12.2012
Oxford course in
E X A M P L English
E EXAMPLE EXAMPLE

www.beds.ac.uk/international April 2018

 6 English Language Requirements
Please complete this section. It is very important to provide all the relevant details to enable us to assess your English level and
determine whether you meet our entry level criteria in English. You will be required to provide evidence of your English level.

Do you have any of the English qualifications listed below? (please tick all that apply):

IELTS CAMBRIDGE GCSE PEARSON TEST NONE

Other (please give details) TOEIC
Grade / score 550 Date achieved

7 Personal Statement
Applicants are required to provide a personal statement in support of your application. On a separate piece of paper please state
your reasons for choosing this course, give details of any relevant experience, your career plans and other relevant supporting
information. In order for your application to be processed your personal statement must explain why you want to study in
the UK, why you wish to come to Bedfordshire, why you have chosen your course, and how it will help you fulfill your
career goals.

8 Physical or other Disability or Medical Condition

Do you have a disability or any condition which might necessitate special arrangements or facilities?
Yes No (If Yes please provide details on a separate sheet of paper)

9 How did you hear about us?

Agent University website Exhibition Search engine

Website / Online directory listing (please specify) Google

Social Media website (please specify)
Other (please specify)

10 References
Names and addresses of two referees (the University may contact referees if required).
Name DIDI TAJEDINE Name Saad Bourouis
University/Company Sup'Management Mauritania University/Company Épi Business School Sousse
Address Tevragh zeine Address Sahloul

City Nouakchott City Sousse

County Mauritania County Tunisia
Postcode 0000 Postcode 4051
Telephone (including international code) +222 33 88 55 10 Telephone (including international code) +216 98 948 640
Mobile (including international code) Mobile (including international code)
Email [email protected] Email [email protected]
11 Data Protection and Declaration
I consent to the University of Bedfordshire’s use of my personal data, including sensitive data, to allow the University to fulfill its administrative
obligations and to process my application. The University shall duly observe its obligations under the General Data Protection Regulations and any
resulting legislation which arise from this application. The information I provide on the application form will be used for the following purposes, to:

• determine my eligibility for entry to the University of Bedfordshire.

• provide me with relevant information to assist me in joining the University (including information about Open Days, scholarships/discounts
and fees, enrollment at the University, my course, my faculty and the University's facilities, the local area, accommodation providers engaged
through the University's approved accommodation system, internships and career opportunities, visa advice and travel advice).
• enable the University of Bedfordshire to compile statistical reports.
• enable the University of Bedfordshire to initiate my student record.

I consent to the University sharing this information with:

• the relevant government departments. This includes: Higher Education Statistical Agency, UK Visas and Immigration, Higher Education Access
Tracker (HEAT), Office for Fair Access and the Office for Students, Student Loan Company, Department for Education and its agencies for the

www.beds.ac.uk/international April 2018

 administration of bursaries for teacher training (for students on professional programmes, Early Years Teacher Status and English as a Foreign Language),
Nursing and Midwifery Council, the Health and Care Professions Council and the General Medical Council (for students on nursing, midwifery, social work or
youth courses), NHS Bursaries Unit (for students on NHS-funded courses). Health Education England and Health Education Thames Valley, and Frontline (a
Government funded body which commissions social work training)
• Public Sector regulatory bodies such as The British Council and the Office for Standards in Education
• bodies which are responsible for professional accreditation of my course, if applicable
• the Police or other authority in relation to crime prevention or investigation, or in association with the Government's Prevent agenda
• accommodation providers (where applicable) who are engaged through the University's approved accommodation system; Liberty Living and Student Village
• UCAS (through the completion of a Record of Prior Acceptance (RPA) in compliance with the UCAS Undergraduate Application and Recruitment Policy), and
NARIC (in order to establish the equivalent level and verify a qualification if applicable)
• John Smith’s bookshop and Aspire Gym so that if, I am eligible to receive a BedsMoney card, I can use it to purchase learning materials or gym membership,
respectively
• any partner of the University which is delivering the programme or whose premises are used for the delivery of a programme, for which I have registered on
with the University
• my sponsor (if any) in order to confirm sponsorship and invoice for payment of fees
• my referees as listed in Section 10 of this application form
• my representative/agent outside the EEA or in my home country (if applicable) as listed in Section 3 of this application form
If I have not used a representative/agent in my home country, I consent to the University sharing this information outside the EEA to a representative/agent
in my home country in order to support my application to the University and for the relevant visa.

In the event that I do not register as a student of the University of Bedfordshire, the University will retain my personal information for the rest of the
academic year for which I have applied plus one further academic year. In the event that I do register, my data will be managed as per the student
agreement which I will sign upon registration.

Signature: Diallo Full name: Mohamed Diallo

I hereby certify that all of the above information is correct and complete, and I wish to apply for admission as a student of the University. I also declare that,
if admitted I shall conform to all the Rules and Regulations of the University of Bedfordshire. I understand that the submission of any misleading information
during the admission process could lead to the immediate cancellation of my application and the withdrawal of any offer made. In the event that I register as
a student of the University of Bedfordshire, I hereby undertake to pay, as and when due, all University fees. I grant permission to the University of
Bedfordshire to request information pertaining to my current or previous visa status in the UK from the Home Office, if necessary.
Signature: Diallo Date: 22/03/2023
Notes for Guidance
General Section 5 Academic History
Before completing the form, please ensure that you read these notes Enter the exact subject name used by the examining body and the name
carefully. You should also read the current University of Bedfordshire of the examining body in full. If you have qualifications obtained outside
literature relating to the course(s) in which you are interested. the UK, you should give details of all examinations taken as preparation
for entry to higher education (e.g School and Higher School Certificate,
Section 1 Personal details Apolytirion, Baccalaureat). Applicants with qualifications obtained in a
Complete this section in BLOCK CAPITALS. If you do not have a current language other than English, must attach a certified English transcript to
valid passport you will need to apply for one. Without a passport we will the form.
not be able to issue you with an Unconditional Offer nor will you be able
to apply for a visa. Section 8 Disability/special needs
Describe your condition and, where it is not obvious, indicate whether
Section 2 Fee status you have special needs.
Please state your country of permanent residence and give details of
who you expect to pay your fees for the proposed course. Section 10 References
Please supply the name and contact details of an academic reference
from your current or previous studies. This need not be related to the
Section 4 Details of course(s) for which you wish to apply
course you are applying for. We will contact referees if required.
Level of Entry – If you qualify for advanced entry to your chosen course
of study please submit your current academic qualifications such as a If you are applying for an MBA you may need to submit a professional
transcript. Please also submit, where possible, the relevant unit's reference. Please see unibeds.info/MBAAD for more details.
syllabus. If you feel your professional experience makes you eligible for Section 11 Data Protection and Declaration
advanced entry please submit evidence. If you wish to indicate an order of
We require your consent for us to store and process the information you
preference for your course choices you may do so. If you do not indicate an supply on this form. We cannot process your application without your
order of preference then it will be assumed that you have none. consent.

DOCUMENT CHECKLIST - DO NOT SEND ORIGINAL DOCUMENTS

Please make sure you include the following documents with your application
Application Form and Data Protection/Declaration signature ✔

Copies of your Academic Certificates/Transcripts ✔

Copy of your English Language Examination Results ✔
Copy of current passport ✔
Personal Statement including why you want to study in the UK, why you have chosen
✔
Bedfordshire, why you have chosen your course and how it will help fulfill your career goals

Previous visa and visa refusal documentation

www.beds.ac.uk/international April 2018