Direct entry application

Application invalid without supporting documents.

Please read the guidance notes before completing the form

You will need to post your qualification certificates to us as soon as possible after completing this form.

1. PROGRAMME OF STUDY:
Start Date: September, Year: Mode Full-time:
Part-time:
Distance-Learning:
2 APPLICANT'S DETAILS
Surname Title (Mr/Mrs/Miss/Ms/Dr/Prof/Rev/etc)
Other Names
Gender: Male Female Date of Birth (dd/mm/yyyy)
Permanent Home Address
Telephone Mobile Email
Address for Correspondence (if different from above)Agent's reference number
Telephone Mobile Email
Nationality
Country of Birth
Country of permanent residence
Applicants not born in the United Kingdom please state date of last entry to the UK (dd/mm/yyyy)
3 FEES/SPONSORSHIP
Who is expected to pay fees?
(Tick as appropriate)		 Applicant Local Education Authority Research Council
Employer Sponsor/Parent/Guardian Other (please specify)
Name and address to which fee invoice should be sent (if other than applicant)
If your attendance at the University will be conditional upon the agreement of your employer, please tick
4 EDUCATION
School since the age of 11
Schools attendedDate StartedDate FinishedExaminations taken and qualifications obtained (include all grades)GradeDate
Education since the age of 16
Institutions attendedDate StartedDate FinishedExaminations taken and qualifications obtained (include all grades)GradeDate
5 EMPLOYMENT EXPERIENCE
If you are currently in employment, please complete this section. If you are currently studying and/or have no work experience, please move on to section 6.
Present position Date of appointment
Workplace address
Telephone
Name and address of employing body (if different from above)
Telephone
Details of previous posts held including from and to dates
6 REFERENCES
At least one of your references must be an academic reference, the second may be academic or from an employer.
First Referee
Name
Position
Address
Telephone
Email
Second Referee
Name
Position
Address
Telephone
Email
7 SUPPORTING STATEMENT
8 ENGLISH LANGUAGE PROFICIENCY
What is your first language?
If your first language is not English please give your IELTS score or TOEFL score (if applicable)
If you have not taken an English test yet, what date do you plan to take it? (dd/mm/yyyy)
What other English Language qualifications do you hold?
How many years have you studied English Language?
9 DISABILITY
Please select from the list below the statement which is most appropriate to you:
000 You do not have a disability nor are you aware of any additional support requirements
010 You have dyslexia
020 You are blind/partially sighted
030 You are deaf/have a hearing impairment
040 You are a wheelchair user/have mobility difficulties
050 You need personal care support
060 You have mental health difficulties
070 You have an unseen disability (e.g. diabetes, epilepsy, asthma)
080 You have two or more of the above difficulties/special needs
090 You have a disability not listed above
Does your disability mean that you have additional support needs? Yes No
If you would like to give further details of required support needs then please do so below.
10 PLANNING STATISTICS
Ethnic origin (this information WILL NOT be made available to Admissions Tutors for selection purposes)
Complete this section only if you have shown in Section 2 of the form that your area of permanent residence is in the UK. Please choose from the ethnic origin terms below which you feel most nearly describes your ethnic origin.
White
British
Irish
Other White
Black or Black British
Caribbean
African
Other Black
Asian or Asian British
Indian
Pakistani
Bangladeshi
Chinese
Other Asian
Mixed
White and Black Carribbean
White and Black African
White and Asian
Other Mixed
Other
Other Ethnic Background
Not Given (UK Domicile)
Overseas Domicile
11 MARKET RESEARCH
In order to assist us to market our courses more effectively, could you please specify how you came to hear of our course?
TV Advert Radio Advert Press advert please specify
Prospectus Course Leaflet Overseas Agent please specify
Friends/Family Careers Office Careers Fair please specify
Live Locally DMU Website Other Website please specify
At University At Work Other please specify
12 CRIMINAL CONVICTIONS
You must declare if you have a relevant criminal conviction, including violence against the person or drug dealing. If you tick the 'Yes' box, the University may ask you for further details.
Yes No
If yes, please give details below.
Please note that if you are convicted of a criminal offence while your application is being processed, you should notify the University.
13 DECLARATION
By submitting this form I declare that, to the best of my knowledge, the information I have given above is correct in every detail. If enrolled, I agree to abide by the Regulations in force at the time.
Tick to agree with the declaration:
To avoid duplicate submissions please click once and wait for a response
Checklist for additional information to send as soon as possible:
  • Proof of English Language proficiency
  • Reference forms
  • Certificates and/or transcripts of your academic qualifications
Send to:The Academic Registrar, De Montfort University, The Gateway, Leicester, LE1 9BH, United Kingdom
Fax: 0116 250 6204
Email: amaddox@dmu.ac.uk