For University use only
Decision:
2016 Entry
Course selector:
BA EARLY YEARS PROFESSIONAL STUDIES
APPLICATION FORM
PLEASE COMPLETE IN BLOCK CAPITALS AND BLACK INK
Title:
Date of Birth:
Last Name:
Age on 1 Sept 2016:
First Name(s):
Where did you hear about this course?
Previous Surname (if applicable):
Address:
Nationality:
How long have you lived in the UK?
Telephone:
Email/Fax:
PREVIOUS EDUCATION
Please provide details of the college(s) or school(s) you attended for your secondary and any tertiary education.
Name of College/School
CURRENT EMPLOYMENT DETAILS
Employer:
Your Job Title:
Full Address:
Postcode:
Workplace Telephone Number:
Dates
PREVIOUS EMPLOYMENT EXPERIENCE (IN DATE ORDER)
Dates
Name of Employer
Position
QUALIFICATIONS
Please list your examinations, professional qualifications and any training taken or currently being followed (copies of
certificates must be enclosed in order for your application to be processed and you must include a transcript detailing
your Foundation Degree results)
Exam Type (eg GCSE,
GNVQ, A Level, City and
Guilds)
Subject
Date
Result/Grade
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 give each of your referees a copy of the enclosed reference notes. Ask your referees to put their reference in a
sealed envelope, sign over the seal, and give the reference to you. Please 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:
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Why you have chosen this degree
How studying for a degree will relate to your interests and/or work
Any activities that you are currently involved in (e.g. work, voluntary or family responsibilities)
How your work or other experiences have prepared you for further study
Which topics are of particular interest and why
Any reading or activity you have already undertaken in your proposed area of study
Your interest in books, films, theatre, music, sport and hobbies
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
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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, stepparents 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.
Signed ............................................................................ Date ...............……….........................
Please return your completed application form to Early Years 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.