StudyAbroadProgramme..

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Newcastle University
Study Abroad Application Form
IMPORTANT: Please read the notes for applicants before completing this.
1. Personal Information
Family Name:
Nationality:
Sex: (Male/Female)
Correspondence Address:
Tel:
Fax:
Permanent Email Address:
First Name:
Country of Domicile:
Date of Birth: (Date/Month/Year)
Permanent/Home Address:
Tel:
Fax:
Passport Number:
(Please supply colour copy/scan of your passport will your application)
Please state where you first heard about Newcastle University:
2. Duration and Status
Please indicate the length of time you are applying for:
□ Full academic year, □ Semester 1 (Sept – Jan), □ Semester 2 (Jan – June)
Please indicate the academic year in which you wish to enter:
□ 2013-2014
□ 2014-2015
Which Study Abroad programme do you wish to study?
□ 2015-2016
□ Arts and Social Sciences
□
Business and Finance
□ Science, Agriculture and Engineering
□
Pre-Med
□
Psychology & Biomedical Sciences
If you have selected the Pre-Med programme, do you intend to apply to a US medical
school?
□ Yes
□ No
Please state which University/College you are currently attending:
Please state your current year of study (e.g. 1,2,3 etc.)
Please state your current GPA/Average grade:
3. Module Choices
Newcastle students normally take 60 Newcastle credits per semester. List in order of priority and
please include alternative module choices.
Title
Code
Semester
Credits
4. English Language Proficiency
If English is your first language, you are not required to complete this section.
If English is not your first language, please give a recent English language test score and
the date is was taken.
IELTS ________________ Score ____________ Date Taken ____________
TOEFL ________________Score ____________ Date Taken ____________
Other ________________ Score ____________ Date Taken ____________
(Please specify)
5. Other Information
Personal Statement
On a separate sheet, please outline briefly why you wish to study at the University of
Newcastle upon Tyne and provide any additional information (interests, work experience
etc) you feel may support your application.
Academic Transcript
Please enclose a recent official academic transcript with your application.
English Language Proficiency
If English is not your native language, please enclose a certified copy of your most recent
IELTS test or equivalent.
References
We require you to submit TWO references from academic referees.
Applications to Science, Agriculture and Engineering Study Abroad Programme
If you are applying to this programme and wish to take level 2 or 3 modules, please enclose
details of the courses you are currently taking (include course name and the core reading
materials for each). This is to assist us to ensure you meet the pre-requisite requirements
for modules you select in this programme.
6. Criminal Convictions
Do you have any criminal convictions?
□ Yes
We need to know about any relevant criminal convictions to help reduce
Applicants who enter x in
□ No
the risk of harm or injury to students caused by the criminal behaviour
of other students. Relevant 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 you should
not reveal them.
the box will not
automatically be excluded
from the application
process, but we may
contact you for further
information before making a
decision.
7. Disability
Please enter disability code (see Note 4)
Please indicate below any specific requirements or facilities you require:
____________________________________________________________________
This information is required to assist the University in meeting the needs of applicants with disabilities.
If you indicate that you have one or more disabilities other than a disability coded (1), a copy of your
application will be forwarded to our Disability Support Service for the purposes of equal opportunities
monitoring and in order to enable potential support needs to be identified as early as possible.
8. Please list details any previous study undertaken in the UK including level of study and details of the Study Visa if
applicable
9. Student Signature
I certify that the information I have provided is true and correct and understand that the
University has the right to withdraw any offer made or cancel any registration if any of
these statements prove to be incorrect. I accept full responsibility for the information
provided on this form.
Signature _____________________________ Date ____________________
10. Academic Reference Information
Please provide below details of your two academic referees.
Name of First Referee
Position (job title)
Department
Tel
Email address
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
Name of Second Referee ______________________________________
Position (job title)
______________________________________
Department
______________________________________
Tel
______________________________________
Email address
______________________________________
Please ask your Referees to ensure that your full name and the name of your home
university are detailed accurately in the reference.
11. Payment Information and Authorisation
SECTION A: To be completed by the student
Please tick yes or no as appropriate.
I will be responsible for paying my tuition fees at Newcastle
□ Yes □ No
I will be responsible for paying my housing costs at Newcastle □ Yes □ No
Name of student____________________________________________________
Signature _________________________ Date _______________________
SECTION B: To be completed by the home university
I agree that _______________________________(enter name of University or college)
WILL cover the tuition fees
□ Yes
□ No
WILL cover the housing costs
□ Yes
□ No
For __________________________________ (insert name of student) while he/she is
participating in the Study Abroad programme at the University of Newcastle upon Tyne.
Full name and job title _______________________________________________
Invoice address ____________________________________________________
Signature _________________________ Date _______________________
Study Abroad Application
Notes for Applicants
1 General Guidance
Please complete the application form in block capitals or typescript. If you have any difficulties completing
the application please contact the Study Abroad Assistant at: [email protected]
2 Courses
Before completing the module choice section of the application form please make sure you have looked at
the Newcastle University website and chosen appropriate modules.
It is your responsibility to ensure that the modules you study at the Newcastle University are approved by
your home institution. You will be able to enrol on modules once you arrive in Newcastle and have up to
two weeks after the semester starts to change your selection should you wish.
3 Criminal Convictions
You must tick the YES box on the application form if you have any criminal convictions. We will then
contact you to provide us with further details. If you do not tick either YES or NO by this question then we
will not be able to process your application form. If you are a convicted of a criminal offence after you
have applied, you must inform us as soon as possible.
4 Disability
Please insert the applicable code on the application form and then expand upon any specific arrangements
you require.
0 No disability
1 You have dyslexia
2 You are blind or partially sighted
3 You are deaf or hard of hearing
4 You use a wheelchair or have mobility difficulties
5 You need personal care or assistance
6 You have mental health difficulties
7 You have a disability that cannot be seen, for example Diabetes, Epilepsy or a heart condition
8 You have two or more of the above
9 You have a condition, disability, special need or medical condition not listed above
5 Data Protection
The University collects information about its students for various academic, administrative, health and
safety reasons. The information is processed in accordance with the 1998 Data Protection Act, and is
disclosed to third parties only with the individual’s consent or to meet a statutory obligation.
6 Checklist
Before sending your application, please use this checklist to ensure you have enclosed all necessary
documentation:
□
□
□
□
□
All sections of the form have been completed
Official academic transcript enclosed/requested
Certified copy of English language test enclosed (if applicable)
References enclosed/requested
Copy/Scan of Passport
Your completed application form, together with all necessary documentation, should be sent to:
Study Abroad Assistant
Newcastle University
International Office
King’s Gate
Newcastle upon Tyne
NE1 7RU UK
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