ࡱ> g l/bjbjVV 4r<r<l'NN\E261111111${4-7d1"""11D%D%D%"1D%"1D%D%r(/T(0ЎdP""|/120E2/7#&7(07(0wbD% 11:% E2""""7N n: Application for Admission to a Research Degree Programme NOT TO BE USED FOR TAUGHT MASTERS & OTHER POSTGRADUATE COURSESFOR OFFICE USE ONLY Reg. No. STUDENTSHIP/BURSARY Ref. No.Standard Entrant Non Standard EntrantATAS schemeOff CampusStudent Services DLD1. Personal details2. Further DetailsSurname/Family NameAge Years Months Male (M) Female (F) Date of Birth Disability/special needs (refer to Notes for Guidance) Country of Permanent Residence _______________________ Country of Birth ___________________________________ Nationality _______________________________________ If born outside the UK Date of first entry to live in the UK Residential Category (refer to Notes for Guidance) For teaching related professionals only UKCC PIN For health related professionals only UKCC PIN First Name(s)Home AddressPostcode (UK Only)Home contact numbers (inc. STD/Area Code)Tel:Fax:E-mail:Correspondence Address (if different)Postcode (UK Only)Home contact numbers (inc. STD/Area Code)Tel:Fax:E-mail:Previous surname/Family Name3. Details of Research Degree for which you wish to applyFull-timePart time (18 hours average weekly)MA/MSc/LLM (by Research) Please tick (* not available Full-Time ) MPhil  PhD  MCh (Res)* MD* (Res) Published Work award* Please specify your area of researchName of proposed supervisor/contact (if known)Please indicate how you heard of these courses4. Details of intended Fee Payment arrangementsi) I will be paying my own tuition fees - Please tick - Yes No ii) I will be in receipt of a grant or scholarship (please give details) Yes No iii) I will be sponsored by my employer or other organisation (please give details) Yes No iv) I am a previous student of the University and will be claiming a fee reduction under the University Postgraduate Scheme. Yes No 5. Physical or other disability or medical condition which might necessitate special arrangements or facilities:6. QualificationsApplicants should list all qualifications taken, whatever the results, in chronological order. If you are awaiting the result of any examination recently taken write PENDING in the grade column. Where examinations are still to be taken, please list. Continue on a separate sheet if necessary.First Degree (please attach a photocopy of the official notification for results known)InstitutionFull Title of AwardFrom (year)To ( year)GradePostgraduate Qualifications (please attach a photocopy of the official notification for results known)InstitutionFull Title of AwardFrom (year)To ( year)GradeProfessional Qualifications (please continue on a separate sheet if required)InstitutionFull Title of AwardFrom (year)To ( year)GradeEnglish Language Qualifications (International Students only)Type of QualificationAwarding BodyMonth YearGrade7. Employment (please indicate your employment experience including any details relevant to the research for which you are applying)EmployerNature of WorkFull-time/Part-timeDatesPresent Employer (if any)NameAddressTel. No.Previous Employers (continue on a separate sheet if necessary) 8. Project Outline and Further InformationPlease give an outline of your proposed Research Project (suggested equivalent A4 length) detailing the aims, methodologies and research activities involved in the project. (You may wish to discuss this section with the relevant Departmental Research Degrees Tutor before completion). 9. ReferencesPlease supply the name and address of the referees to whom you will send the reference form Your referees should be able to tell about your academic ability, character and your suitability for research work.1st Referee2nd RefereeNameNameAddressAddressOccupationOccupationTel. No.Tel. No.NB: The reference may accompany this application or be sent to the University separately 10. Previous applicationsGive details (with dates) of any previous application, or of correspondence relating to admission to study for a higher degree at this University.11. Criminal Convictions If you have a criminal conviction please tick the box:12. Declaration Declaration: I confirm that the information given on this form is true, complete and accurate and no information requested or other significant material information has been omitted. I have read the Notes for Guidance for Completion of the Application Form. Applicant's Signature: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Please return to: Senior Research Administrator (Admissions) Graduate Research Office University of Central Lancashire Preston PR1 2HE Lancashire UK I do not want to be contacted by the University with details of its courses or its other products or services  REFERENCEStatement by Referee Applicants Full NameName of RefereeMA/MSc/LLM (by Research) / MPhil / MD (Res) / PhD (*delete as applicable)Post / Occupation / Relationship to applicantAddressTel. No (including STD):Fax. No. (including STD):Email:Can this reference be discussed with the applicant Yes NoCan this reference be revealed to the applicantYesNo Notes for the guidance of referees In order to select those students who will benefit from their chosen programme of study, the University requires a supporting statement from a referee. Your reference about the applicant should, if possible, cover the following: Suitability for a research degree Intellectual qualities including previous academic performance and any relevant subject experience through work or study Personal characteristics including evidence of ability to sustain study at the level of their chosen research Career aspirations How long have you known the applicant (please complete in black ink)  Signed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Please affix official stamp where appropriate at end of the statement) Please Return to: Senior Research Administrator (Admissions) Graduate Research Office University of Central Lancashire Preston PR1 2HE Lancashire UK  REFERENCEStatement by Referee Applicants Full NameName of RefereeMA/MSc/LLM (by Research) / MPhil / MD / PhD (*delete as applicable)Post / Occupation / Relationship to applicantAddressTel. No (including STD)Fax. No. (including STD)Can this reference be discussed with the applicant Yes NoCan this reference be revealed to the applicantYesNo Notes for the guidance of referees In order to select those students who will benefit from their chosen programme of study, the University requires a supporting statement from a referee. Your reference about the applicant should, if possible, cover the following: Suitability for a research degree Intellectual qualities including previous academic performance and any relevant subject experience through work or study Personal characteristics including evidence of ability to sustain study at the level of their chosen research Career aspirations How long have you known the applicant (please complete in black ink)  Signed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Please affix official stamp where appropriate at end of the statement) Please Return to: Senior Research Administrator (Admissions) Graduate Research Office University of Central Lancashire Preston PR1 2HE Lancashire UK  Postgraduate Research Programme Application:  Planning Statistics Ethnic origin (this information will not be made available to Admissions Tutors for selection purposes) Please choose from the ethnic origin terms printed here the one which you feel most nearly describes your ethnic origin and write its code in the boxes If you have used the code (19), (29), (39), (49), or (80), please describe your ethnic origin using your own words in the space provided: 11 White - British 31 Asian or Asian British - Indian42 Mixed White and Black African 12 White - Irish 32 Asian or Asian British - Pakistani 43 Mixed White and Asian19 Other White Background33 Asian or Asian British - Bangladesh49 Other Mixed background21 Black or Black British - Caribbean34 Chinese or Other Ethnic background - Chinese 80 Other Ethnic background22 Black or Black British - African39 Other Asian background 90 Not known29 Other Black Background41 Mixed White and Black Caribbean 98 Information refused As appropriate, we reserve the right to check your application for entry to the UK with the relevant British Government Office. All the personal information provided above, together with any further information the University obtains is used to process your application. It may also be used by the University to undertake research to plan or improve our services. In addition the University may advise you of other study opportunities and services provided by it. 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