Please complete this form only
once, irrespective of the number of
modules you are attending.
Technical Accreditation Scheme
Email the completed and signed
form to: TAS@warwick.ac.uk
Personal Information
Application 2013-2014
University Number (for office use only):
Last Name (family name)
This is the name under which your file will be registered
and the name you should use on any future
correspondence with us
Informal Name (This is any name you wish to be known by)
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
Date of Birth
Gender
Male
 Female 
Course Details
Have you ever been a student at the
University of
Warwick/Loughborough/Coventry/Cranfield/
Bradford/Southampton/York/Aston?
Please enter
tick asyour
appropriate
Please
university number, if known
Communication with you
Home address
Your permanent home address. This address will also be
used as the address for correspondence unless you give
details below:
Correspondence address
Email
Telephone
Mobile
No
Coventry
Southampton



Warwick
Cranfield
York



Loughborough
Bradford
Aston



Nationality and residence details
Nationality
Country
of Birth
Country of permanent residence
The country in which you have been normally resident,
except for periods of temporary absence
Academic History
Are you currently studying at an educational
institution?
YES 
If yes please give the expected end date of that course
Name of Institution:
Course End Date:
NO 
Qualifications held Please state the titles of your qualification(s)
as it appears on your official transcript & certificates
Name of University /
College and Country
Dates attended
(e.g. 1995 –1999)
Degree awarded and
class e.g. BA (Hons) 2i
Degree with date
Principal subjects taken
Degree expected and
class e.g. BA (Hons) 2i
Degree expected
with date
Principal subjects taken
Qualifications Pending
Name of University /
College and Country
Dates attended
(e.g. 1995 –1999)
English Language Qualifications
Have you been educated in the UK for at least a year?
YES 
NO 
Have you been educated in an English speaking country?
YES 
NO 
Have you been educated entirely in English for your degree?
YES 
NO 
I took / will be taking a language test on (date)
Type of test taken
IELTS 
Test Score
The Score is
TOEFL 
WELT 
Disabilities and Specific
Learning Difficulties
Dyslexia
Blind/Partially Sighted
Deaf/ hearing impairment
Autism/Asperger Syndrome
Other not identified above:
 Need Personal Care Support
 Mental Health Difficulties
 Wheelchair User
Unseen special need e.g. Diabetes
Are you a registered disabled person?
 YES
 NO
Do you have any relevant criminal
convictions?
 YES
 NO
The University welcomes applications from disabled people
and those with specific learning difficulties and considers
them on the same academic grounds as other candidates.
In order that the University can provide appropriate advice
and guidance on the services and facilities available, it is
helpful to know in advance if you have a disability or any
specific learning difficulties.
Relevant criminal convictions are only those convictions for
offences against the person, whether of a violent or sexual
nature, and convictions for offences involving unlawfully
supplying controlled drugs or substances where the
conviction concerns commercial drug dealing or
trafficking. Convictions that are spent (as defined by the
Rehabilitation of Offenders Act 1974) are not considered to
be relevant and need not be disclosed except in the
circumstances set out below.
You must answer yes if either of the following statements
applies to you:
 You have a relevant criminal conviction that is not spent.
 You are serving a prison sentence for a relevant criminal
conviction.
If you enter yes in the box you will not be automatically
excluded from the application process. However the
University will want to consider the application further or
ask for more information before making a decision.
Equal Opportunities Monitoring
(UK Students only)
Please help us to make our equal opportunities policy
effective by placing a tick in the box which is applicable to you
Asian
 Indian
 Pakistani
 Bangladeshi
 Chinese
 Other Asian Background
Mixed Race
 White & Black Caribbean
 White & Black African
 White & Asian
 Other mixed background
Black
 Caribbean
 African
 Other black background
White
 British
 Irish
 Other white background
Declaration
I hereby apply for admission to postgraduate studies on the Technical Accreditation Scheme and I confirm that the information provided
above is correct to the best of my knowledge. I hereby give my consent for the organisations providing this Scheme to share this
information solely for the purposes of this Scheme. I understand that any offer of admission may be withdrawn if I cannot provide
documentary evidence of any statements on this form. I also understand that modules on this Scheme include mandatory post module
assignments and that I am expected to complete such assignments to the best of my ability.
I hereby give my consent for my marks to be released to Jaguar Land Rover and to be shared by the organisations providing this
Scheme solely for the purposes of this Scheme.
Confidentiality: You must not publish or disclose to any third party any confidential information or documents which relate to the
Jaguar Land Rover business or its trading specialities. Any misuse or unauthorised disclosure of any information both during and after
employment with the Company may result in disciplinary or legal action, as appropriate.
Please refer to the Jaguar Land Rover Declaration of Confidentiality for full terms.
Signature
Date