Erasmus Mundus Special and Inclusive Education
Student Application Form – Guidance Notes
APPLICATION DEADLINE: 31st OCTOBER 2013
ENTRY REQUIREMENTS:
A first degree
(equivalent to 180
ECTS/UK Degree) from
a recognised university
or college preferably in
E
a related field of
I
education, in line with
T
national legislation in all
H
3 partner countries.
E
R
At least 2 years’
practitioner experience
related to the field of
education and/or special
and inclusive education
A first degree
(equivalent to 180
ECTS/UK Degree) from
a recognised university
or college in any subject
area, in line with
national legislation in all
O
three partner countries
R
At least 5 years'
practitioner experience
in the field of education
and/or special and
inclusive education
Required English
Language level
(see link for
information under
subtitle English
A Language
N Qualifications –
D http://www.roehamp
ton.ac.uk/admission
s/erasmusmundus/s
pecial-and-inclusiveeducation/entryrequi
rements/index.html)
SELECTION PROCESS:
 First stage: Applications screened against the above entry requirements.
You will be informed by January 2014 if you have not met these.
 Second stage: Joint Selection Board constituting all 3 EU partner institutions
meet in January to review and approve student applications against the
consortium’s selection criteria and attention will be given to the first/second
degree, grades and English language qualifications attained by applicants. Due
weight will also be given to the stated rationale for undertaking this international
programme, level of qualification, ability to communicate clearly, the nature and
relevance of prior professional experience and the manner in which international
co-operation and understanding will be fostered after completion of the
programme.
 Third stage: All decisions are sent to EU for approval between February and
March 2014. Outcome of this stage will be released to successful and
unsuccessful candidates in May/June 2014.
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FINANCING THE PROGRAMME:
 The EU commission grants scholarships to the highest qualified students fulfilling
all above criteria, selected by the consortium. These scholarships cover tuition
fees and contribute to accommodation, travel and installation costs (depending
on which category – as detailed in section 7).
WHAT YOU NEED TO INCLUDE IN YOUR APPLICATION:
Please note that incomplete applications (including missing supporting
documents) will not be accepted.
 Complete Application Form (all 10 sections)
 Complete Disability and Ethnicity Form.
 Photocopy evidence of your English language qualifications (originals will be
asked for if your application is successful)
 Copies of your degree transcripts, certificates and/or progress to date (these
must be supported by a certified translation if the original is not in English, Czech
or Norwegian)
 A personal statement in support of your application (2 x A4 maximum) (section 9
of application form)
 2 reference letters
 A copy of your passport
 A copy of your CV
PLEASE RETURN COMPLETED FORM TO:
International Admissions Officer,
Admissions,
Erasmus House,
Roehampton University,
Roehampton Lane,
London, SW15 5PU, UK
or
erasmusadmissions@roehampton.ac.uk
APPLICATION FORM STARTS ON NEXT PAGE.
EMSIE Student Application Form
2
Erasmus Mundus Special and Inclusive Education
Student Application Form
Please complete in black ballpoint or type.
SECTION 1: PERSONAL DETAILS:
Surname/Family
Name:
Title: Mr Mrs Miss Ms
Forenames/First
Names:
Other
Country of
Permanent
Residence:
Date of birth:
DD
MM
YYYY
Nationality:
Country of Birth:
If you were not born in the UK, state
date of last entry to UK:
If you were not born in the Norway,
state date of last entry to Norway:
If you were not born in the Czech
Republic, state date of last entry to
Czech Republic:
If you are resident in any of the 3 countries – UK, Norway or Czech Republic –
please indicate the country (ies) and the date from which you have been
resident here:
Address:
Permanent
Address if
different:
Postcode/Zip
Code:
Postcode/Zip
Code:
Country:
Country:
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Telephone
Number:
Telephone
Number:
Fax
Number:
Fax Number:
E-mail
Address:
E-mail
Address:
Mobile:
Mobile:
Valid Until:
SECTION 2: EDUCATION
Education – start with your most recent qualifications. If you have not yet received
your award, indicate when you expect to do so.
(include copies of your degree transcripts, certificates and/or progress to date (these must
be supported by a certified translation if the original is not in English, Czech or Norwegian))
Higher Education
Full Title of
Award
Institution/
Awarding Body
Dates From/ To
Fulltime/
Parttime
Grade/
Result
SECTION 3: PROFESSIONAL QUALIFICATIONS
(include any relevant copies of these qualifications (these must be supported by a certified
translation if the original is not in English, Czech or Norwegian))
Title of award
Professional Body
Date
Please continue on a separate sheet if needed.
Are you a qualified teacher?
Yes
No
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If you have answered yes – which country did you qualify in?
SECTION 4: PROFESSIONAL EXPERIENCE
Relevant Work Experience
Name of
Organisation
Dates From/ To
Position Held
Fulltime/
Parttime
Main Areas of
Responsibility
Please continue on a separate sheet if needed
SECTION 5: ENGLISH LANGUAGE QUALIFICATIONS
(include evidence of your English language qualifications)
TOEFL (Please state if computer based):
Overall Score
Written Score
Date achieved
IELTS:
Overall Score
Reading
Writing
Listening
Speaking
Date achieved
Other English Language Qualifications:
Date achieved:
SECTION 6: DISSERTATION
Dissertation: Please state your preliminary dissertation topic.
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SECTION 7: FINANCE
Are you applying for the Erasmus Mundus scholarship?
Yes
No
If yes, which scholarship Category are you applying for?
Category A:
Students who come from a country other than an eligible applicant country (therefore,
non-EU) and who are not residents nor have carried out their main activity (studies,
work etc) for more than a total of 12 months over the last five years in one of these
countries
Category B:
Students who do not fulfil the Category A criteria above. They are students who are
either residents or have carried out their main activity (studies, training or work) for more
than a total of 12 months over the last five years in one of the EU Members States,
Liechtenstein, Iceland or Norway.
If you do not receive the scholarship will you still take part in the programme?
Yes
No
If yes, please indicate how you will finance your study on the programme
SECTION 8: REFEREES (include 2 recent reference letters with application)
Referee 1
Referee 2
Name:
Name:
Address:
Address:
Postcode/Zip
Code:
Postcode/Zip
Code:
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Country:
Country:
Telephone
Number:
Telephone
Number:
Fax Number:
Fax Number:
E-mail Address:
E-mail Address:
Mobile:
Mobile:
How you know
them/relationship:
How you know
them/relationship:
SECTION 9: PERSONAL STATEMENT
Personal Statement: - describe your academic interests and reasons for applying.
Include details of work experience you consider relevant to your proposed study,
career objectives and relevant non-academic achievements. (Maximum of 2 sides
A4).
SECTION 10: DECLARATION
a) I certify that the statements made by me on this form are correct.
b) I understand that, if admitted to the Erasmus Mundus programme, and if my funds
should at any time during my course prove to be inadequate, the Erasmus Mundus
programme will not be able to provide financial assistance either by grant or by
remission of fees.
c) I understand that in signing below I agree to Roehampton University, University
of Oslo and Charles University processing my personal data (as defined by the
Data Protection Act 1998), for administrative purposes as notified to the Office of
the Information Commissioner.
d) I understand that in signing below I agree that my data may be used (if
proposed/selected for the scholarship) for the purposes of evaluating the Erasmus
Mundus Programme and will be made available to the Agency, the EM National
Structures, the EU Delegations and the Erasmus Mundus Student and Alumni
Association, acting as stakeholders of the programme.
Signature of applicant
EMSIE Student Application Form
Date
4
Erasmus Mundus Special and Inclusive Education Disability and ethnicity form
This form will be detached by the University and will not be used in the selection process.
Part 1 - Disability
Roehampton University aims to support students with disabilities or specific learning
difficulties with their studies to the best of its ability. More information about Disability
Services and the kind of support they can and cannot provide can be found at:
http://www.roehampton.ac.uk/Disabilities/
Please note: We will require evidence of your disability or medical condition (such as a
letter from your doctor) in order to put support in place. This remains confidential on our files.
Please tick/indicate in the appropriate box below if you wish to record that you have a
disability, or a specific medical condition:
Dyslexia
Asperger’s Syndrome/Autism
Deaf/hard of hearing
Wheelchair user
Mobility difficulties
Mental health difficulties
Blind/partially sighted
An unseen disability or medical condition (e.g. diabetes, epilepsy, asthma)
Please specify:……………………
Any other please give details:…………………………………………………………………..
I agree to the information given above to be passed on by Disability Services as
necessary. I understand that this will enable them to liaise with my Academic department
and other departments within the University to best support me in my studies.
Part 2 - Ethnicity
In order to help the University ensure that its equal opportunities policy is being carried out
effectively you are asked to provide the following information:
Please tick/indicate in the appropriate box that best describes your ethnic origin:
a) Asian and Asian British
Indian
Pakistani
Bangladeshi
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Other Asian background (please specify)………………………………………
b) Black and Black British
Black Caribbean
Black African
Other ethnic background (please specify)………………………………………
c) Chinese, Chinese British or other ethnic group
Chinese
Other ethnic background (please specify)………………………………………
d) Mixed and mixed British
White and Black Caribbean
White and Black African
White and Asian
Other mixed background (please specify)………………………………………
e) White and White British
English
Scottish
Welsh
Irish
Any other white background (please specify)………………………………………
a) I consent to the information given in this supplement being stored electronically within
Roehampton’s Student Information System. I understand that strict rules on security and
confidentiality of data will be observed and the provisions of the Data Protection Act
1998 will apply on the use of and access to information. This consent will cover the
period of my studies at the University unless it is withdrawn by me in writing.
b) I understand that in signing below I agree to University of Roehampton, University of
Oslo and Charles University processing my personal data (as defined by the Data
Protection Act 1998), for administrative purposes as notified to the Office of the
Information Commissioner.
c) I understand that in signing below I agree that my data may be used (if proposed/selected for
the scholarship) for the purposes of evaluating the Erasmus Mundus Programme and will be
made available to the Agency, the EM National Structures, the EU Delegations and the
Erasmus Mundus Student and Alumni Association, acting as stakeholders of the programme.
Name:
Date:
Signature:
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