Prima Facie Case for the Award of PhD by Published Work
Application Form
This form has been designed to be word-processed.
Subject Area, Degrees and Mode of Study
In which subject area(s) are you interested?
Personal Details
Title
Gender
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
Do you have funding?
Please note that the majority of Anglia Ruskin research students are self funded or sponsored
by employers or research funding bodies.
No
/ Yes
(please put a X in the appropriate box)
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
Do you have any unspent criminal convictions? Yes
No
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)
1
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)
Full-time /
Part-time
Qualifications Completed or Relevant Training Undertaken (please list most recent first)
Qualification
Subject
Grade
Date Awarded
Expected
Grade
Date (mm/yy)
Qualifications Pending or On-going Training
Qualification
Subject
Professional activities in the last five years (Please list most recent first)
From
To
Employer
Position Held
Class/Grade
2
Professional Qualifications
Date Awarded
Qualification
Subject
Class/Grade
Professional Body Membership
Professional Body
Date Joined
Employment
Current Employer (if applicable)
Name of Organisation
Address
Department
Job Title
Date appointed
Previous Employers (if applicable) (please list most recent first)
Organisation
Position Held
From (mm/yy)
Details of the candidate’s relationship with Anglia Ruskin University
3
To (mm/yy)
References of publications on which the application is based
Please note that you may be required to provide copies of all publications cited
Summary Please summarise, in not more that 1,000 words, how the cited work
contributes to knowledge and represents a coherent study.
Period Please indicate the period over which the research contributing to the published
works was undertaken.
Extent of contribution by collaborating researchers. Please indicate the extent to
which collaborating researchers have contributed to the design, analysis, conduct of the
research and writing up for publication of the cited works.
4
Referees – Please complete the following details of two Academic Referees
Name
Name
Address
Address
Postcode
Postcode
Telephone no.
Telephone no.
Email address
Email address
Post/Occupation
Post/Occupation
Declaration. I the undersigned confirm that the cited research has not been submitted,
whole or in part, for a research degree at any other University
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:
Sarah.abbott@anglia.ac.uk
or
Sarah Abbott
Admissions Office
Anglia Ruskin University
Bishop Hall Lane
5
Chelmsford
Essex
CM1 1SQ
FOR OFFICE USE ONLY
Data entry date
6
SID