Application Form

Fields marked * must be completed. This form cannot be saved as a partial document. If you wish to apply you must complete the whole form in one attempt. You may find it easier to copy and paste your personal statement from another previously saved document. You must also read How to Apply before completing this form.

1. Course applied for
DTDILM6 MA/MSc Information and Library Management (Distance Learning Postgraduate)

*Month & year of entry:	(All courses start in September or October unless specified in course details)
*Stage i.e. Year 1:
*How did you hear about this course?	Details:

2. Personal Details See How to Apply for details.

*Title: *Sex: *Date of birth: DD/MM/YYYY (Minimum age 17 years)

*First/given name:
*Surname/family name:

Home Address
*House Number & Street:
District/Area:
*Town/City:
*County/State:
*Postal/ZIP Code:
*Country:
Daytime Telephone:
Home Telephone:
Mobile Telephone:
*E-Mail Address :

Postal Address (if different from home)
House Number & Street:
District/Area:
Town/City:
County/State:
Postal/ZIP Code:
Country:
Daytime Telephone:
Home Telephone:
Mobile Telephone:
E-Mail Address :

NOTE: You will receive a confirmation of your application via e-mail.

3. Further Details

*Area of permanent residence:	See How to Apply for details.
*Country of birth:
*Nationality:
Date of first entry to the UK (if applicable):	DD/MM/YYYY

4. Criminal Convictions
If you have a relevant criminal conviction, select this box. See How to Apply for details.

5. Disability / Special Needs
If you have a disability or special needs, please select from the list. See How to Apply for details.

6. School/college and university education See How to Apply for details.

From	To	Name of Institution	Mode of Study	Course Title	Classification

7. Qualifications completed See How to Apply for details.

Date	Subject	Level (eg GCSE, A-level, BTEC, Other)	Result/Grade

Please upload copies of your certificates if available (GIF, JPG or PDF format, 100kb max)

8. Qualifications not yet completed See How to Apply for details.

Subject	Level of award	Expected completion date

Please upload copies of your most recent transcript if available (GIF, JPG or PDF format, 100kb max)

9. English language proficiency See How to Apply for details.

Are you an International student? Yes No (If No, please go to Question 10)

Was English the language of instruction in your previous institution? Yes No
Number of years you have studied in English:

I hold the following qualifications:

IELTS	Score (if known)	Date	Location:
TOEFL	Score (if known)	Date	Location:

Other	Score (if known)	Date	Location:

If test yet to be completed, please state date to be taken:		Location:
IELTS TOEFL Other

Please upload a copy of your certificate (GIF, JPG or PDF format, 100kb max)

10. Additional training See How to Apply for details.

Subject	Organising institution	Completion date

11. Employment history (please include your current employment) See How to Apply for details.

Name of employer/organisation	Nature of Work/Job Title	From	To	FT/PT

12. Personal statement
* Minimum 250 words in English. See How to Apply for details.

13. Referees (at least one required) See How to Apply for details.

Please note: it is the responsibility of the applicant to ensure that a relevant reference is sent to the University.

Referee 1
*Name in full:
Email address:
*Address:
Telephone:

Referee 2
*Name in full:
Email address:
*Address:
Telephone:

14. Declaration See How to Apply for details.

I confirm that, to the best of my knowledge, the information given in this form is correct and complete. I have read How to Apply, in particular the instructions regarding this section. I understand what they say and I agree to abide by the conditions set out there, which I accept as a condition of this application.
By clicking on the 'Submit Application' button I agree to the above declaration.