Application Form

OFFICE USE ONLY

Applicant number Date received
D D M M Y Y Y Y
Section 1
Please return this Form, in the envelope provided, to: Central Recruitment, Thames Valley University, St Mary’s Road, Ealing, London W5 5RF

If you would like additional information or help with filling in this Form, please contact the Learning Advice Centre on 0800 036 8888.
Details entered onto this Form will be transferred to computer. This information will be treated confidentially in accordance with the Data Protection Act, 1998.

Your choice of course (please use CAPITAL letters)

Please state which course you wish to
study (including Stage, Part, Phase or
Level, where relevant).

If you are applying for a music course

please state your main instrument

Please indicate your proposed start date. M M Y Y Y Y

Some courses may be offered at Ealing,
Slough and Reading. Where this is the case,
please indicate (✔) your first choice of Ealing Slough Reading
campus.

Some courses are available in several modes Part-time, day Part-time, day and evening Full-time
of study. Where this is the case, please
indicate (✔) your preferred mode of study. Distance/open learning Part-time, evening

Personal (please use CAPITAL letters)

Title (eg Ms/Mrs/Mr/Dr)

Surname (Family name)

Previous surname if changed

First name(s)

Gender Male Female

Date of Birth D D M M Y Y Y Y
Home address

Postcode

Telephone Home Work

e-mail Mobile

Nationality

Country of birth

Country of domicile or
permanent residence

Non European Union (EU) Applicants

Please note that non-EU Applicants not born in the EU, please state:
students are liable for the
full costs of their study Date of first entry to the EU D D M M Y Y Y Y
programmes.
Date of most recent entry to the EU D D M M Y Y Y Y
Date from which you have been granted:

Exceptional leave to remain in the UK D D M M Y Y Y Y

Full refugee status in the UK D D M M Y Y Y Y
Indefinite leave to remain in the UK D D M M Y Y Y Y
Date on which your student visa was issued (if applicable)
D D M M Y Y Y Y
 Section 2
Paying for your course
If you are applying for a short course or a foreign language course, you need only complete Section 4, sign and date the Declaration
in Section 5 and complete Section 6.

Who will pay your fees? Research Council Family member

Local Education Authority (LEA) Employer*

Yourself Other

*if your employer is paying your fees, please enclose a sponsor letter with this Application Form.

If an LEA, which one?

Please indicate (✔) if you have previously received

an educational award from UK public funds? Yes No

If Yes, please provide details Funding body

Course
Dates of attendance From M M Y Y Y Y To M M Y Y Y Y

Previous education and work experience

Course title
If you are currently attending, or have
previously attended TVU, please give the title
the course you are undertaking
of or have Dates of attendance
undertaken.
From M M Y Y Y Y To M M Y Y Y Y
Not previously studied an HE course in the UK
For monitoring purposes, please indicate
(✔)
whether you have previously taken any Previously attended an HE course at another UK institution
higher education course (degree, HND or

higher level) in the UK. Returning to complete an HE course started at another UK institution after a period away

Transferring from an HE course at another UK institution

Wherever possible, TVU offers credit for any relevant prior learning and experience which you may have.
Please indicate (✔) if you would like details of our Accreditation of Prior Learning/Experiential Learning Scheme.

Please outline any work experience you Job title

have had (both paid and unpaid) which
you consider relevant to your chosen Name of organisation
course of study.
From M M Y Y Y Y To M M Y Y Y Y
Please include details of any special
responsibilities. Continue on a separate sheet Duties
if necessary.

Job title

Name of organisation

From M M Y Y Y Y To M M Y Y Y Y
Duties

Job title

Name of organisation

From M M Y Y Y Y To M M Y Y Y Y
Duties
 Section 3

Examinations
Please list all subjects taken, whatever the result, starting with the most recent. If you are awaiting the result of any examination, please write ‘pending’ in the
Result/grade column. You should also include any recent training and professional updating and all music grade/diploma qualifications.

Examination Subject(s) Year Result/ CATS points

Please provide details of title, level, issuing body and country taken grade (if relevant)

Membership of professional organisations

Please include membership of any professional body or organisation (please give your registration number where relevant)

Information to support your application

Please use this Section of the Form to provide information to support your application, including your reason(s) for wishing to take the course of study and the
benefits you expect to gain from it. Please continue on a separate sheet if necessary.
Equal Opportunities Monitoring
Please note, this Section of the Form will be detached before your application for a course is considered.

We would encourage you to give information about your disability to the University so that we can endeavour
to make reasonable adjustments for you. This information will only be available to Admissions and Disability
Staff and will not be made available to anyone else without your explicit permission.
Section 4
Please use CAPITAL letters

Surname (Family name) Date of Birth D D M M Y Y Y Y

Please use exactly the same format of your surname as you have used in Section 1 of this Form.

Ethnic Origin
TVU is committed to the pursuit of equality White (British) 11 Asian or Asian British – Bangladeshi 33
and social justice and has a policy of equal
White (Irish) 12 Chinese 34
opportunities. Please help us to evaluate the
effectiveness of this policy. White (Scottish) 13 Asian other 39

Irish Traveller 14 White & Black – Caribbean 41

Please indicate (✔) which you feel best
reflects your ethnic origin. Other white background 19 White & Black – African 42

Black or black British – Caribbean 21 White & Asian 43

Black or black British – African 22 Other mixed background 49

Black other 29 Other ethnic background 80

Asian or Asian British – Indian 31 Information refused 98

Asian or Asian British – Pakistani 32

Disability
No Disability 00 Require personal care support 05
Thames Valley University welcomes and
supports students with learning difficulties and Dyslexia 01 Mental health difficulties 06
disabilities. Blind/partially sighted 02 Unseen disability eg diabetes, asthma 07
To help us to provide appropriate support
services, please indicate (✔) which term is Deaf/hearing impairment 03 Multiple disabilities 08
descriptive of your disability. Wheelchair user/mobility disability 04 Autistic Spectrum Disorder 10

A disability or special need not listed above (please specify) 09

Please indicate any support TVU can provide to
help you in your studies or examinations.

Criminal Conviction(s)
This part of the Form MUST be completed.
If you do not tick either the ‘Yes’ or ‘No’ box, we will not process your application. In such circumstances,
we will contact you to get the information, but this will delay your application.

Do you have any criminal conviction(s)? Yes No

You must tick the YES box if you have a conviction, not including:
• a motoring offence that you received a fine or three penalty points for;
or
• a spent sentence (as defined by the Rehabilitation of Offenders Act 1974), except for certain courses.
Please be aware that for certain courses, particularly in teaching, health, social work and other courses involving work with children, you must tell
us about any criminal conviction(s), including spent sentences and cautions.

NOTES
• If you are not sure whether to tell us about a previous conviction, you should get more advice from your local Citizens’ Advice Bureau or Probation Service,
or from the National Association for the Care and Resettlement of Offenders (NACRO). You can also contact a solicitor, but you may have to pay for legal
advice.

• If you are convicted of a criminal offence, after you have applied, you MUST let us know immediately.

• If you are serving a prison sentence, you must tick the ‘Yes’ box. You must also give the prison address as your postal address on the front page of this
Form, and a Senior Prison Officer must support your application.
 Section 5
References Reference 1
Many of our courses, particularly those at
Name
postgraduate level, require you to provide
2 references. Please check whether the Position
course you are applying for, has this as a
requirement for entry. Address

Wherever possible, one Referee should Postcode

relate to your current or recent work and
Daytime telephone number
one to any current or recent study you have
undertaken. e-mail
Please give one copy of the Reference Form
enclosed to each Referee to complete and
return to TVU in the envelope provided.
Reference 2
Name
Please ensure that you fill in your name
and the course you are applying for on the Position
Reference Form before despatch.
Address

Postcode

Daytime telephone number

e-mail

Have you complete all relevant sections of the forms, including,

✓ Equal Opportunities?
✓ Ethnic Origin?
✓ Criminal Convictions?

Declaration
To the best of my knowledge, the information I have given on this Form is correct.

Signature of applicant

Date

Thames Valley University Thames Valley University Thames Valley University

St Mary’s Road Wellington Street Crescent Road
Ealing Slough Reading
London W5 5RF Berkshire SL1 1YG Berkshire RG1 5RQ
06/07
Marketing information
Section 6
Please return this Form, in the envelope provided, to: Central Recruitment, Thames Valley University, St Mary’s Road, Ealing, London W5 5RF

Course applied for

Which campus are you appllying to study at: Ealing Reading Slough

1 – Very important 2 – Quite important 3 – Not that important 4 – Unimportant

Please indicate the importance of various sources of information in helping you to choose your course at TVU.
1 2 3 4 1 2 3 4
TVU website Leaflet or flyer posted to you
TVU prospectus Information e-mailed to you
TVU course-specific brochure Other website or online directory
Personal experience of study at TVU Recruitment fair or exhibition
Word-of-mouth ECS / UKCOSA / British Council
TVU visit or open day International student recruitment agency
Course recommended by employer Course directory (eg UCAS directory)
Careers advice (eg through schools, Newspaper or magazine advert, online advert
Connexions or NextStep)
Other, please specify:
Careers publication

How important were the following factors in your choice of course at TVU?
1 2 3 4 1 2 3 4
Relevance of course Good facilities (eg learning resources, computer suites)
Only place that offers the course Entry requirements
Course content Flexible study options
Course duration Professional accreditation / industry recognition
Location Employment prospects
Accommodation Fees / cost of study
Teaching method Funding and bursaries
Course reputation Other, please specify:
University reputation

Any other comments?

Thank you for your feedback.

Reference Form 1

Applicant’s name To be completed by the applicant

Course applied for To be completed by the applicant
The above has quoted you as a Referee in his/her application to Thames Valley University.

Thank
you for taking the time to How long have you known the applicant and in what capacity?
complete this reference.

As many candidates apply, selection is
often difficult. Your comments will make
a significant contribution to assessing What do you consider to be the applicant’s main strengths and weaknesses?
the applicant. Strengths Weaknesses

Your comments will be treated in the

strictest confidence. Please let us know
if you would like this reference to be
acknowledged.

Please
tick (✔) Yes No What is your overall opinion of the applicant’s suitability for this course?

PTO

Reference Form 2

Applicant’s name To be completed by the applicant

Course applied for To be completed by the applicant
The above has quoted you as a Referee in his/her application to Thames Valley University.

Thank
you for taking the time to How long have you known the applicant and in what capacity?
complete this reference.

As many candidates apply, selection is
often difficult. Your comments will make
a significant contribution to assessing What do you consider to be the applicant’s main strengths and weaknesses?
the applicant. Strengths Weaknesses

Your comments will be treated in the

strictest confidence. Please let us know
if you would like this reference to be
acknowledged.

Please
tick (✔) Yes No What is your overall opinion of the applicant’s suitability for this course?

PTO
Please return this Form, in the envelope provided, to: Central Recruitment, Thames Valley University, St Mary’s Road, Ealing, London W5 5RF

To help us further with our assessment of this candidate, it would be helpful if you would rank the applicant relative to his/her peer group
eg, relative to other, similarly qualified employees, or to fellow undergraduates, or to fellow postgraduates.

Peer group for comparison:

Capacity % rating Outstanding Excellent Very good Good

in peer group Average Below average Not known
95%+ 90%–94% 75%–89% 60%–74%
Intellectual/academic
Fluent & logical
communication
Orally

Written

Ability to work hard

Perseverance

Leadership

Creativity

Social skills

Is there any other information which you Name

feel is relevant to this application?
Position
Please continue on a separate sheet if
necessary. Address

Postcode

Telephone Fax

e-mail

Signature Date

Please return this Form, in the envelope provided, to: Central Recruitment, Thames Valley University, St Mary’s Road, Ealing, London W5 5RF

To help us further with our assessment of this candidate, it would be helpful if you would rank the applicant relative to his/her peer group
eg, relative to other, similarly qualified employees, or to fellow undergraduates, or to fellow postgraduates.

Peer group for comparison:

Capacity % rating Outstanding Excellent Very good Good

in peer group Average Below average Not known
95%+ 90%–94% 75%–89% 60%–74%
Intellectual/academic
Fluent & logical
communication
Orally

Written

Ability to work hard

Perseverance

Leadership

Creativity

Social skills

Is there any other information which you Name

feel is relevant to this application?
Position
Please continue on a separate sheet if
necessary. Address

Postcode

Telephone Fax

e-mail

Signature Date