2016
Entry
PART-TIME DEGREES
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 the Programme?
Previous Surname (if applicable):
Address:
Nationality:
How long have you lived in the UK?
Telephone:
Email:
Please indicate the degree course in which you are interested. If you are interested in more than one degree please
indicate them in order of priority.
Degree
Classical Civilisation/Ancient History & Classical Archaeology
English and Cultural Studies
French Studies
Health and Social Policy
History
Humanities
Social Studies
Priority
EXEMPTIONS/ADVANCED STANDING
We are happy to consider requests for exemptions from modules on the basis of academic or professional
qualifications. If you wish to be considered please complete the APL Form located at:
http://www2.warwick.ac.uk/services/aro/dar/quality/categories/courseapproval/apel/
PREVIOUS EDUCATION
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Please provide details of all schools, colleges and universities you have attended (from secondary education)
Name of school/college/university:
Dates:
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)
Exam Type (eg GCSE, GNVQ, City and
Guilds)
Subject
Date
PLEASE LIST ANY QUALIFICATIONS FOR WHICH YOU ARE CURRENTLY STUDYING
Course/qualification/establishment
Subject
Result/Grade
Expected
completion date
PREVIOUS EMPLOYMENT EXPERIENCE, IN DATE ORDER, UP TO THE PRESENT
Dates
Name of Employer
Position
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 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 completed application form along
with reference(s) to the University of Warwick with your completed application form.
PERSONAL STATEMENT
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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
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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
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Male
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Female
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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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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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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
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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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No
No
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If yes, please tick the relevant boxes:
 Autistic Spectrum Disorder
 Mental health difficulty
 Blind/partially sighted
 Asperger Syndrome
 Deaf/hearing impairment
 Personal care support required
 Multiple disabilities
 Wheelchair user/ mobility difficulties
 Other disability
 A specific learning difficulty, e.g. dyslexia
 An unseen disability (e.g. Diabetes, epilepsy, asthma)
 Other additional needs (please specify below)
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 form to: Admissions Team (Part-Time Degrees), Centre for Lifelong Learning,
University of Warwick, Coventry, CV4 7AL or by email to: CLLadmissions@warwick.ac.uk
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