FOR OFFICE USE:
Date of Interview:
2016
Entry
Decision:
Course Selector:
A P P L I C A T I O N F O R M
FOUNDATION DEGREE IN EARLY CHILDHOOD
PLEASE COMPLETE IN BLOCK CAPITALS AND BLACK INK
Title:
Date of Birth:
Last Name:
Age on 1 Sept 2016:
First Name(s):
How did you learn about Foundation Degrees?
Previous surname (if applicable):
Address:
Nationality:
How long have you lived in the UK?
Telephone:
Email/Fax:
Day:
Eve:
PREVIOUS EDUCATION
Please provide details of all schools, colleges and universities you have attended (from secondary education)
Name of school/college/university:
Dates:
WORK EXPERIENCE AND RESPONSIBILITIES
Please provide details of any paid or voluntary work experience, and information regarding any responsibilities you
have had at home or in the community.
Employer/Type of Work or Area of Responsibility:
Dates:
ACADEMIC QUALIFICATIONS
Please list any O-levels, GCSEs, GNVQs, A levels or other qualifications obtained at school or college.
Please enclose photocopies of certificates with your application form.
Exam Type: (eg GCSE, GNVQ, City and
Subject:
Date:
Result/Grade:
Guilds)
TRAINING OR PROFESSIONAL QUALIFICATIONS
Please provide details of any training or professional course/qualifications you have undertaken or are doing at
present.
Name of Course/Qualification
Awarding body/training provider:
Dates/length of course:
REFERENCES
The University requires either one academic reference (from a tutor at college or someone else who has taught you
in a formal setting) or two character references from people who know you well. You should not ask a member of
your family, but an employer, colleague, or other professional person would be suitable. Please note that academic
references must relate to study completed within the last five years. All references should be dated, have been
written within the last six months and, wherever possible, should be on headed paper. Personal references should
always include a contact address and telephone number.
Please give each of your referees a copy of the enclosed reference notes, and return your reference(s) to The
University of Warwick with your completed application form.
PERSONAL STATEMENT
Please write about 500 words explaining why you would like to study for a degree. You should cover the following
themes:
 Why you have chosen this degree
 Which topics are of special interest and why
 How your work or other experiences have prepared you for further study
 How you can demonstrate your motivation to complete a course of Higher Education
 Whether you have done any reading in your proposed area of study.
It would also be interesting to know about your interests and hobbies. Please feel free to include details of these in
your statement.
Please continue on a separate sheet if necessary and then turn over to complete the
Equal Opportunities Questionnaire and Declaration.
EQUAL OPPORTUNITIES
The University of Warwick and its partner colleges are committed to a policy of equal opportunities and will not
discriminate against any applicant or student on the basis of age, gender, nationality, ethnicity or religion. Please
help us to make our equal opportunities policy more effective by ticking the boxes below.
Arab
Asian or Asian British-Indian
Black or Black British-African
Chinese
Mixed – White and Asian
Mixed – White and Black Caribbean
Other Asian background
Other ethnic background
White
Gender
Male
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Asian or Asian-British Bangladeshi
Asian or Asian British-Pakistani
Black or Black British-Caribbean
Gypsy or Traveller
Mixed – White and Black African
Not known
Other Black background
Other mixed background
Female 
If you do not wish to disclose this information, please tick here
Religious Belief
Buddhist
Christian
Hindu
Jewish
Muslim
Sikh
Spiritual
Any other religion or belief
Information Refused
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Sexual Orientation
Bisexual
Gay man
Gay woman/lesbian
Heterosexual
Other
Information Refused
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PARENTAL EDUCATION
The following question is about your parents’ level of education. This includes natural parents, adoptive parents,
step-parents or guardians who have brought you up.
Do any of your parents (as defined above) have any higher education qualifications, such as a degree, diploma or
certificate of higher education?
Yes
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No
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Don’t know
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Information refused
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ADDITIONAL NEEDS
We welcome applications from candidates with additional needs and consider them on the same academic grounds
as those of other applicants. It is helpful to know in advance if you have any special requirements and the Senior
Tutor’s Office will be pleased to help assess your needs (024 765 23761).
Are you registered disabled?
Do you have a disability/additional needs/medical condition?
Yes
Yes
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If yes, please tick the relevant boxes:
Autistic Spectrum Disorder
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Mental health difficulty
Blind/partially sighted
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Asperger Syndrome
Deaf/hearing impairment
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Personal care support required
Multiple disabilities
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Wheelchair user/ mobility difficulties
Other disability
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A specific learning difficulty, eg dyslexia
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An unseen disability (eg Diabetes, epilepsy, asthma)
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Other additional needs (please specify below)
No
No
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DECLARATION OF CRIMINAL RECORD
The University asks all its applicants whether they have any criminal convictions. If you have a criminal record, we
can still consider you for a place but the University will ask for details of the offence. Depending on the nature of the
conviction, the University may give further consideration to your admission before confirming any offer. You are not
required to disclose spent convictions.
Do you have any criminal convictions?
Yes
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No
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DECLARATION
Please sign and date your application to confirm that the information you have provided is accurate to the best of
your knowledge and that you understand that you must be working directly with children in a paid or voluntary
capacity for a minimum of 5 hours a week throughout the course.
Signed ............................................................................ Date
...............………...........................................................
Please return your completed application form and employer support form plus copies of certificated relevant
qualifications to Early Childhood Foundation Degree Programme, The Centre for Lifelong Learning, Westwood
Campus, University of Warwick, Coventry, CV4 7AL or by email to: early.yearsfd@warwick.ac.uk
If you have any queries please telephone 024 7652 4736.