LANGUAGES 4 ALL – APPLICATION FORM 2016/17
Submitting this application does not guarantee a place on your chosen course. You
will be contacted on your student e-mail account to confirm if you have been
successful in securing a place.
Thank you for your interest in studying on our Languages for All programme.
Please complete all sections using BLOCK CAPITALS and typescript or black ink
and either hand it in at Macaulay Hall reception, or post it to:
Languages for All, Macaulay Hall, Headingley Campus, Leeds, LS6 3QN
Date Received:
Applications received by email will not be processed
App. No:
Please do not write in any shaded boxes.
* indicates a Mandatory Field
Prog Code:
Year:
CRN 1:
CRN 2:
1. Course Details
Please complete all fields as fully as possible. Those marked * are compulsory. For help completing this section, please
refer to the Languages 4 All timetable.
Class Code &
Language:*
EXAMPLE: AR1b Arabic
Level:*
Day:*
Time:*
Beginners
Wednesday
18.30
Location:*(Headingley
Campus/Rose Bowl)
Headingley Campus
1st Choice
2nd Choice
2. Personal details
Title:*
Mr / Miss / Mrs / Ms / Dr / other:
Last Name (s)*
Gender*
First Name*
Date of birth*
dd/mm/yyyy
Mobile number:
Middle Name (s)
Male / Female
Previous Family
Name (s)
Leeds Beckett Student Email:* (your confirmation will be sent to this address)
@student.leedsbeckett.ac.uk
Name of Full Time Course: (This will be used to confirm your eligibility)*
Faculty:*
Leeds Beckett Student ID:*
3. Please complete the Country of Birth and Nationality sections. If you were not born in the European Union, please
ensure that you complete the date of entry fields. If we need further information with regard to your fee status, you
will be contacted by the Student Admissions Team.
I am a permanent resident*
In the UK
In the EU
Outside EU
Select the Box which applies to
you
Country of Birth:*
Nationality:*
If not born in the UK, date of first entry to
live in the UK dd/mm/yyyy*
Do you have an unrestricted right to live in
the UK?*
Yes / No
4. Contact details
We will send all correspondence to your permanent home address unless you have specified an alternative address for
correspondence.
Please provide us with a telephone number that we may use if we have to contact you with regard to your application.
Home address – permanent residence*
Correspondence address (if different)
Address Line 1
Address Line 2
Address Line 3
City
Post Code / Zip
County
Country
Tel No (inc dialling code)
Dates at this address
5. Emergency Contact details
Emergency Contact Name
Relationship to you
Contact Number
6. Previous Study & Qualifications *
Please provide us with the highest qualifications that you have taken previously to Leeds Beckett. (these do not have
to be language related)
If you have previously studied Languages before, please also indicate this below.
You can continue on a separate sheet if necessary.
Qualification
Institution of Study
Location
Subject
Type
Mode
FT/PT
Grade/
Score
To
mm/ yy
8. Criminal Convictions* Please note that the University operates in accordance with legislation concerned with the
rehabilitation of offenders and often having a criminal record is not a bar to entry. However, we do need to ensure that
all declarations of criminal records are properly investigated in order to discharge our duty of care to other members of
the University community. Please do not give details here; if you declare an unspent criminal conviction you will be
contacted separately.
Do you have any criminal convictions that are not spent
Yes
No
9. Disability Information*
We treat this information in confidence and may use this information to contact you to discuss whether or not you may
require any extra resources or support to undertake your chosen course. We will not use this information to determine
whether or not to make you an offer of a place
Please give details of any support you might
need
0 No Known Disability
1 Specific Learning Difficulty e.g. dyslexia
2 Blind or Partially Sighted
3 Deaf or Hard of Hearing
4 Wheelchair User or have mobility difficulties
T Autistic Spectrum or Asperger Syndrome
6 Mental Health difficulties
A disability which cannot be seen
7
e.g. diabetes, epilepsy or Heart Condition
8 Two or more of the above
9 Disability, Special Need or Medical Condition not listed above
10. Ethnicity*
We treat this information in confidence and may use this information to contact you to discuss whether or not you may
require any extra resources or support to undertake your chosen course. Please indicate your ethnicity.
White
Black or Black British
Asian or Asian British
Mixed
White British
Caribbean
Indian
White and Black Caribbean
White Other
African
Other Black
Background
Pakistani
White and Black African
Bangladeshi
White and Asian
Chinese
Other Asian Background
Other Mixed Background
Other ethnic Background
Gypsy/Traveller
DECLARATION:*
I agree that by signing below, I am giving the University permission to use my personal information for the purpose of
processing my application. Including all of the University’s online systems, for which I will receive email notifications, and,
if I am offered a place at the University which I then accept, will form part of my University student record.
I certify that the information I have given is complete and accurate. In submitting this signed application form, I confirm
that I wish to firmly accept an offer of a place that may be made to me, and agree to the terms of this offer as enclosed.
Signature _________________________________
Date: ______________________
Notes on the enrolment process
Forms must be submitted in paper format. Emailed application forms will not be processed.
•
Please complete all sections of the application form in full. Incomplete forms cannot be accepted.
•
Please refer to the FAQS, Assessing Your Language Level and the Course Timetable documents on
the Languages for All website for information about courses, course codes, times, locations and levels
www.leedsbeckett.ac.uk/languagesforall
•
Please print, complete and sign your form and either post it to the address on the front of the form,
or you can drop it in at Macaulay Hall reception, Headingley Campus
•
Please send your completed application form to us as soon as possible. Places are limited and on a
first-come, first-served basis. You may only enrol on one free language course.
•
Submitting an application form does not guarantee a place on your chosen course. You will be
contacted on your student e-mail account to confirm if you have been successful in securing a place.
•
If the course you have applied for is full, we will advise you by email and put your name on a waiting
list. You will be contacted again should a place become available.
Thank you for your interest in Languages for All. If you have any queries, please contact us on
languages4all@leedsbeckett.ac.uk