STUDY ABROAD 2015-2016
APPLICATION FORM
* Please ensure that all Sections are completed before the form is sent to the University. *
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SECTION 1
Application for (please tick appropriate box):
Full year (28 Sept 2015 – 4 June 2016)
Semester One – teaching period only (28 Sept 2015 – 18 Dec 2015)*
Semester One – full semester (28 Sept 2015 – 26 Jan 2016)*
Semester Two (1 Feb 2016 – 4 June 2016)
* The examination period for Semester One takes place from 12–27 January. Students applying for Semester One, who
are required to recommence their studies at their home university in early January, may apply to attend for the Semester
One teaching period only. Alternative assessment arrangements will be available (see www.qub.ac.uk/studyabroad).
Surname
Forenames
(in full)
Date of Birth
Marital Status
day/month/year
Male
Female
(Mark appropriate box)
Country of Domicile
Nationality
Social Security Number
(For US Nationals only)
I give permission for my Social Security Number to be
disclosed to the US Department of Education for the
purposes of verifying enrolment.
Address for correspondence
Home Address (if different)
Dates you will be at this address
Dates you will be at this address
Telephone Number
Telephone Number
Email
Email
University/College at which you are currently enrolled
Degree Program for which enrolled (eg. BA)
Major Subject
Current Year of Study (eg. 2nd)
Cumulative GPA
Office Use Only
Date received:
………………………..
Application Number:
………………………
SECTION 2
1.
Proposed Study at Queen’s
Which modules do you intend to study at Queen’s University? Please give numbers and titles. A full-time
workload is 60 Units per semester. This is normally 3 modules, each worth 20 Units, although some subject
areas also offer half modules and double modules.
Please consult the Course Catalogue to make your module selection at https://qsiscat.qub.ac.uk. Note that
many modules have pre-requisites. Previous experience of the subject is usually required for modules above
Level 1. Some modules might only be available to students undertaking a full degree programme.
At UK universities, undergraduate degrees have a duration of 3 years. You can identify the level of a module
from the module code. Codes starting with a 1 are Level 1, those starting with a 2 are Level 2 and those
starting with a 3 are Level 3. For example, HIS1003 is a Level 1 module. You should not select modules that
start with a number higher than 3.
The semester in which a module is normally offered is indicated in the Course Catalogue.
AUTUMN SEMESTER
Example
Module Code
Module Title
HIS1003
Exploring History 1
A
2nd Choice
B
2nd Choice
C
2nd Choice
SPRING SEMESTER
Example
A
2nd Choice
B
2nd Choice
C
2nd Choice
Module Code
Module Title
HIS1004
Exploring History 2
SECTION 2
2.
Qualifications
NB
AN OFFICIAL TRANSCRIPT OF THE COURSES YOU HAVE TAKEN WITH THE
GRADES OBTAINED MUST BE ENCLOSED WITH THIS APPLICATION.
Please list additional courses currently being studied, or to be taken before your proposed Study Abroad at
Queen’s University, that are not included on your transcript.
Date
3.
Subject
Course Title
Financial Resources
Please state how you intend to finance your course of study at Queen’s. The University may require documentary
evidence of this.
4.
Further Information
Please give some information about yourself, including any relevant experience which you have had, any work or study
abroad, and your intellectual, social and other interests. (You may wish to attach a personal statement on a separate
sheet.)
Please state if you have physical or other disabilities or medical conditions which may necessitate special
arrangements. Continue on a separate sheet if necessary.
Please state how you heard about Queen’s University Belfast.
SECTION 3 *Please complete this section only if your native language is not English*
English Language Qualification
It is a condition of admission that applicants whose native language is not English should have an acceptable English
Language qualification such as IELTS or TOEFL. The score required can vary between Schools within the University.
Qualification
IELTS (British Council)
Grade Obtained
Date Obtained
TOEFL
Other English Qualification – please
give details
*Please enclose a copy of your English Language qualification certificate with this application.*
If you do not have a suitable English Language qualification you will be required to obtain one prior to admission to the
Study Abroad programme. The University has an english language unit which offers pre-sessional intensive English
courses. An additional fee is applicable.
SECTION 4
Please print and sign this application and submit it to the address below, along with:
(1) an academic transcript
(2) an academic reference
from your home university.
“I certify that the information contained in this application form is complete and accurate.
I consent to the University processing the information in this form for administrative purposes, including consideration
of my application in accordance with the provisions of the Data Protection Acts 1984 and 1998 (see below). I
understand that my signature indicates my agreement for Queen's University Belfast to release to my home institution
any information they might request, including a transcript of results achieved at QUB, and any other information
deemed relevant by Queen's University Belfast.”
Please select from the list below
Please select from the list below
Signature
............................................................................................
Date
...................................……..
Please return this form and accompanying documents to:
Exchange and Study Abroad team
Careers, Employability and Skills
Queen’s University Belfast
BELFAST BT7 1NN
Northern Ireland, United Kingdom
Telephone: +44-28-9097 5255
Fax:
+44-28-9097 2828
Email: studyabroad@qub.ac.uk
Early application is advised. Latest date for receipt of applications is normally
31 May 2015 for entry in September 2015 and 31 October 2015 for entry in February 2016.
Queen's University Belfast is registered as a data controller with the Office of the Information Commissioner. As such,
it is entitled to hold personal information on those who enquire about admission, on applicants and on current and
former students. These data are held in electronic and paper format. By signing the application form, applicants are
consenting to the processing of the data by the University for administrative purposes, including consideration of their
applications, but only insofar as it is permitted to do so within the constraints of the Data Protection Act 1998. Full
information can be found in the University's official notification.