Application for
Postgraduate Studies
Learning and Development Centre (T&L),
Senate House, University of Warwick, Coventry, CV4 8UW, UK
Personal Information
* This information is required by Student Records
Student Number:
Last Name (family name)
This is the name under which your record will be registered and
the name you should use on any future correspondence with us
Title
Please add the title you normally use
Forename(s) (given names) in full
Please add all your forename(s) in the order in
which they normally appear
Informal Name (This is any name you wish to be known by)
Date of Birth (DD/MM/YYYY)*
Gender *
Course Details
Course of Study: Postgraduate Award in Teaching and
Learning in Higher Education
Department: Learning and Development Centre
Communication with you
Permanent home address *
Your permanent home address. This address will also be
used as the address for correspondence unless you give
details below:
Postcode
Mobile
Telephone
Fax
Email
We will correspond with you mainly by email
Correspondence address *
From:
To:
(if temporary)
If you are a resident away from home, eg as a
student, or you may be away from home for a
significant period, please give you contact address
and dates. This is the address/email address to
which we will send official correspondence relating
to your application.
Correspondence Email
Postcode
Mobile
Telephone
Fax
PhD expected completion date
Note: working towards a PhD submission deadline is not
considered as extenuating circumstance and does not
warrant an extension.
Are you currently studying towards any
other courses or qualifications?
If yes, please give details and the expected end date.
Supporting Statement
Note: all applicants must complete this section
Please use this space to briefly answer the following questions:
 What teaching experience do you have for the following year? (please note that you need to be doing a minimum
of 10 hours teaching at Warwick over the duration of the course.)
 How will the course fit with your current role?
 How will you ensure that you have sufficient time to complete the course?
You may continue on a separate sheet if necessary
(Approx. 500 words)
Equal Opportunities Monitoring
The University welcomes applications from people with
specific needs and considers them on the same academic
grounds as those from other candidates. It is helpful to
know about your specific needs in advance so that we can
discuss any appropriate reasonable adjustment with you.
Applicants with specific needs are encouraged to contact
the disability co-ordinator, tel: 024 7657 3734 or Email:
disability@warwick.ac.uk.
 No Disability
 Mental Health Condition
 Specific Learning Difficulty
 Physical/Mobility Issues
 Blind/Visual Impairment
 Deaf/Hearing Impairment
 Multiple Impairments/ conditions
 Social/Communication Impairment
 Unseen/Long Standing Condition
 Other conditions not listed
Are you a registered disabled person?
Yes

No 
Declaration
I hereby apply for admission to postgraduate studies at the University of Warwick and I confirm that the information
provided above is correct to the best of my knowledge. I understand that any offer of admission may be withdrawn if I
cannot provide documentary evidence of any statements on this form.
I confirm I attended the ‘Introduction to Teaching & Learning in Higher Education’ on ___/___/_____
(Please note you will need to include the letter of completion from the Introduction session in your PGA portfolio)
Signature
Support from supervisor to enrol on the course
I can confirm this student is teaching a minimum of 10 hours this academic year
Name
Role
Signature
Additional
Comments
