Research Degrees Application Form
This form should be completed in conjunction with the booklet Higher Degrees by Research or the
Research & Development Services website (http://www.anglia.ac.uk/research)
Please complete this form in BLOCK CAPITALS
Course Details
Subject Area
__________________________________________________________
Award Title
M.Phil
M.Phil/PhD
PrD (Health)
Mode of Study
PhD
DBA
PrD (Built Environment)
Full Time
Part Time
EdD
Proposed Date of Entry
-
Personal Details
Title____________________________________
Male/Female
Surname/Family Name____________________________________
Previous Surname_______________________________________
First Name(s)___________________________________________
Date of Birth (dd-mm-yy)
-
-
Home address
Contact Address (if different from home address)
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Postcode
Postcode
Telephone no._______________________
Telephone no._______________________
Email address_______________________
Email address_______________________
Fees Information
Who is expected to pay your fees?
Yourself
Sponsor
Research Funding Body
Further Details
Country of Domicile
______________________________________
Country of Birth
______________________________________
Nationality
______________________________________
Have you been permanently resident in the UK/EU for the last 3 years for other than
educational purposes? Yes
No
Please give date of entry _______________
Learning Support Needs
Do you have any learning support needs or mobility requirements?
(If your answer is ‘yes’ a member of our Student Support Services will be in contact with
you about your requirements)
FOR OFFICE USE ONLY
-
Data entry date
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-
SID
Yes
No
Education, Qualifications and Training
Higher Education/Further Education/Secondary Education (please list most recent first)
Name of Institution
From (mm/yy)
To (mm/yy)
FT/PT
Continue on separate sheet if necessary
Qualifications Completed or Relevant Training Undertaken (please list most recent first)
Qualification
Subject
Grade
Date Awarded
Continue on separate sheet if necessary
Qualifications Pending or On-going Training
Qualification
Subject
Expected Date (mm/yy)
Grade
Continue on separate sheet if necessary
Professional Body Membership
Professional Body
Date Joined
Continue on separate sheet if necessary
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Employment
Current Employer
Name of Organisation____________________________________________________
Address_______________________________________________________________
_______________________________________________________________
Department__________________________
Job Title___________________________
Date appointed_______________________
Previous Employers (please list most recent first)
Organisation
Position Held
From (mm/yy)
To (mm/yy)
Continue on separate sheet if necessary
Supporting Information
Research Topic
Please indicate in general terms the topic that you are interested in researching. Continue
on a separate page if necessary.
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Research Skills
Publications
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Referees – Complete the following details of two Referees
Name_______________________________
Name_______________________________
Address_____________________________
Address_____________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
__________________________________________
Postcode
Postcode
Telephone no._______________________
Telephone no._______________________
Email address_______________________
Email address_______________________
Post/Occupation______________________
Post/Occupation______________________
Data Protection Act 1998
I agree to the University processing personal data contained in this form or other data which the
University may obtain from me or other people. I agree to the processing of such data for any
purposes connected with my studies or my health and safety whilst on the premises for any legitimate
reason including communication with me following the completion of my studies.
In addition, I agree to the University processing personal data described as Sensitive Data within the
meaning of the Data Protection Act 1998, such processing to be undertaken for any purposes as in
indicated in the declaration above.
Declaration
I certify that to the best of my belief this information I have provided is complete and true
Signature of Applicant___________________________________
Date______________
Certification of Qualifications
Please note that all applicants must include copies of the following when returning this application
form:

Academic Certificates (officially translated if not UK)

Academic Transcripts, including subjects studied and grades achieved (officially translated if
not UK)

English Language certificate (if not UK)
Please return this form to:
Claire Duke
Admissions Office
Anglia Ruskin University
Bishop Hall Lane
Chelmsford
Essex
CM1 1SQ
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