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MOD
Academic Partnerships
Student Registration with the University of Exeter
TO BE COMPLETED BY THE PARTNER INSTITUTION ADMINSTRATION OFFICE
Personal Information
Title: Dr, Rev, Mr, Mrs, Miss, Ms
Surname or Family Name:
Forenames in full:
Any previous Surname:
University of Exeter Student Number (if a returning student):
Partner Institution Student Number (if applicable):
Date of birth:
Gender: Female / Male / other
Permanent Address and Postcode:
Term time address and postcode (if different from above):
Term Time Accommodation Type (tick one):
 Parental/guardian home (2)
 Own residence rented or owned (7)
 Rented – sharing with other students (8)
 Privately run Halls of Residence (9)
 Other (4)
E-mail address:
Telephone (Home):
Telephone (Work):
Programme Information
Programme Title: Continuing Professional Development (CPD)
Start date:
Expected end date:
Mode of study (please delete as appropriate):
PT / FT / Distance Learning
New to the University of Exeter this year?
Yes / No
New to this Programme this year?
Yes / No*
* If No: Continuing on programme in:
2nd / 3rd / 4th / 5th year of study
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Additional Information for New Entrants Only
Nationality:
Country of permanent residence:
Ethnic origin (tick one):
 White (10)
 Chinese (34)
 Gypsy or Traveller (15)
 Other Asian background (39)
 Black or Black British - Caribbean (21)
 Mixed- White and Black Caribbean (41)
 Black or Black British – African (22)
 Mixed - White and Black African (42)
 Other Black background (29)
 Mixed - White and Asian (43)
 Asian or Asian British – Indian (31)
 Other mixed background (49)
 Asian or Asian British – Pakistani (32)
 Arab (50)
 Asian or Asian British – Bangladeshi (33)
 Other ethnic background (80)
Previous Qualifications (please tick your highest level to date):
 UK doctorate degree (DUK)
 Higher National Diploma (HND)
 Level 3 qualifications of which
 Non-UK doctorate degree
(J30)
none are subject to UCAS Tariff
(DZZ)
 Foundation course at level J (J49)
(P92)
 Other qualification at level D
 Certificate in Education (CertEd)
 Level 3 qualifications of which
(D80)
or Diploma in Education (DipEd) (i.e.
all are subject to UCAS Tariff
 UK masters degree (MUK)
non-graduate initial teacher training
(P93)
 Non-UK masters degree (MZZ) qualification) (J49)
 Level 3 qualifications of which
 Integrated
 Other qualification at level J (J80)
some are subject to UCAS Tariff
undergraduate/postgraduate
 Certificate of Higher Education
(P94)
taught masters degree on the
(CertHE) (C20)
 14-19 Higher Diploma (level 2)
enhanced/extended pattern
 Higher National Certificate (HNC)
(P51)
(M2X)
(C30)
 Welsh Baccalaureate
 Diploma at level M (M41)
 Higher Apprenticeship (level 4)
Intermediate Diploma (level 2)
 Certificate at level M (M44)
(C44)
(P52)
 Postgraduate Certificate in
 Other qualification at level C
 Other qualification at level 2
Education or Professional
(C80)
(Q80)
Graduate Diploma in Education
 Undergraduate credits (C90)
 14-19 Foundation Diploma
(M71)
 Diploma at level 3 (P41)
(level 1) (R51)
 Other taught qualification at
 Certificate at level 3 (P42)
 Welsh Baccalaureate
level M (M80)
 Award at level 3 (P46)
Foundation Diploma (level 1)
 Taught work at level M for
 AQA Baccalaureate (Bacc) (P47)
(R52)
institutional credit (M90)
 A/AS level (P50)
 Other qualification at level 1
 UK first degree with honours
 14-19 Advanced Diploma (level 3)
(R80)
(HUK)
(P51)
 Higher education (HE) access
 Non-UK first degree (HZZ)
 Scottish Baccalaureate (P53)
course, Quality Assurance
 First degree with honours
 International Baccalaureate (IB)
Agency (QAA) recognised (X00)
leading to Qualified Teacher
Diploma (P62)
 Higher education (HE) access
Status (QTS)/registration with a
 International Baccalaureate (IB)
course, not Quality Assurance
General Teaching Council (GTC) Certificate (P63)
Agency (QAA) recognised (X02)
(H11)
 Cambridge Pre-U Diploma (P64)
 Mature student admitted on
 Professional Graduate
 Cambridge Pre-U Certificate
basis of previous experience
Certificate in Education (H71)
(P65)
and/or admissions test (X02)
 Other qualification at level H
 Welsh Baccalaureate Advanced
 Other qualification level not
(H80)
Diploma (level 3) (68)
known (X04)
 UK ordinary (non-honours) first  Other qualification at level 3 (P80)
 Student has no formal
degree (JUK)
 Level 3 qualifications of which
qualification (X05)
 Foundation degree (J10)
some or all are subject to UCAS
 Not known (X06)
 Diploma of Higher Education
Tariff (P91)
(DipHE) (J20)
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Last Institution Attended:
Parental Education:
Do any of your parents (this includes natural parents, adoptive parents, step-parents or guardians who have
brought you up) have any higher education qualifications, such as a degree, diploma or certificate of higher
education?
 Yes  No  Don't know
TO BE COMPLETED BY EACH STUDENT
Student Declaration
Data Protection Notice – The University of Exeter requires this information for education purposes and your
personal data will be processed in accordance with the University’s Registration and Current data Protection
legislation (found here: http://www.exeter.ac.uk/dataprotection/). This information will not be disclosed to any
unauthorised third parties. To receive a copy of our data protection notice please contact us.
Disability Information
Disability (tick one):
 No known disability. (A)
 A social/communication impairment such as Asperger's syndrome/other autistic spectrum disorder. (B)
 Blind or a serious visual impairment uncorrected by glasses. (C)
 Deaf or a serious hearing impairment. (D)
 A long standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease, or epilepsy. (E)
 A mental health condition, such as depression, schizophrenia or anxiety disorder. (F)
 A specific learning difficulty such as dyslexia, dyspraxia or AD(H)D. (G)
 A physical impairment or mobility issues, such as difficulty using arms or using a wheelchair or crutches. (H)
 A disability, impairment or medical condition that is not listed above. (I)
 Two or more impairments and/or disabling medical conditions. (J)
Do you collect Disabled Students’ Allowance?
 Not applicable
 I have a disability and claim the allowance
 I have a disability but do NOT claim the allowance
If you have disclosed a disability to the institution where you are studying, this may be shared with the
University. The University will disclose information about your disability to internal personnel and departments
only, such as the University of Exeter AccessAbility service and other internal service providers etc, to assist
you in your studies.
If you do not want your personal information processed in this way please tick 
Students’ Guild Membership and Data Transfer From Your Student Record
You are automatically a member of the University of Exeter Students’ Guild at point of Registration. Details on
opting out of University of Exeter Students’ Guild are outlined in the Students’ Guild Memorandum and
Articles of Association which can be found on the Students’ Guild website (http://www.exeterguild.org/).
Some personal data is passed to the Guild to enable to provision of membership services (e.g. voting in
elections, joining societies). In addition information relating to disability/ethnicity has been requested to help
monitor and ensure fair representation of membership.
This additional personal data is passed only on explicit agreement from yourself.
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Please select one of the following options to release data to the Guild:
 The University may release my disability/ethnicity data
 The University may not release my disability/ethnicity data
Criminal Convictions
To help reduce the risk of harm or injury to our students and staff caused by the criminal behaviour of other
students we must know about any relevant* criminal convictions that an applicant has. Please read the
following carefully.
You should tick the box below only if you have a relevant* criminal conviction that is not spent, or have a case
pending, which you have NOT previously declared to the University of Exeter.
This includes criminal charges awaiting court hearing, as well as criminal and custodial convictions that are
pending. Unless you are registered on a programme which involves working with children and/or vulnerable
adults, you are NOT required to declare any non-relevant conviction(s) at this stage.
*For more information on what is considered relevant, see the list in the next question.
Please note that you will be required to declare and notify us of any future criminal charges (both relevant and
non-relevant) brought against you during the time that you remain as a registered student of the University of
Exeter. This includes all criminal and custodial convictions.
Do you have a relevant criminal conviction or court case to declare? 
If you have ticked the box above, please indicate the nature of your relevant criminal conviction (or case
pending) from the following offences:
 Any kind of violence (but not limited to) threatening behaviour, offences concerning the intention to harm,
or offences which resulted in actual bodily harm.
 Offences listed in the Sex Offences Act 2003
 The unlawful supply of controlled drugs or substances where the convictions concern commercial drug
dealing or trafficking
 Offences involving firearms
 Offences involving arson
 Offences listed in the Terrorism Act 2006
By signing your name below and dating the form, you are agreeing to the terms stated above and to
automatic registration with the University of Exeter. If you have any questions, please contact the Registry,
University of Exeter, Streatham campus, Exeter EX4 4QL
I agree to abide by the regulations of the University and to accept the jurisdiction of the Senate
(www.exeter.ac.uk/calendar). I am aware that committing Academic/Research Misconduct, including but
not limited to plagiarism and/or collusion, is an offence under the relevant Code of Good Practice on
Managing Academic/Research Misconduct. I confirm that the information on this form is correct to the best of
my knowledge. I understand that credit-bearing courses include some form of assessment as an integral part
of the course.
Applicant signature:
Date: