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B : APPLICATION FORM FOR ADMISSION TO A FULL-TIME UNDERGRADUATE COURSE
FOR USE BY INTERNATIONAL STUDENTS ONLY
NOT TO BE USED FOR APPLICATIONS TO MEDICINE, DENTISTRY, NURSING/MIDWIFERY, PHARMACY OR SOCIAL WORK. APPLICANTS FOR THESE COURSES MUST APPLY THROUGH UCAS
Please complete in BLOCK CAPITALS using black ink and referring to the notes on the back page.
QUB SCHOOL
NAME OF QUB COURSE
(in order of preference)
1.
2.
UCAS NUMBER
(if applicable see note 2)
FAMILY NAME :
GIVEN NAME(S) :
TITLE (MR/MISS/MS/MRS) :
GENDER: (M/F)
PREVIOUS FAMILY NAME :
CORRESPONDENCE ADDRESS :
HOME ADDRESS (IF DIFFERENT) :POSTCODE:POSTCODE:
TELEPHONE NUMBER :
TELEPHONE NUMBER :
E-MAIL :
MOBILE TELEPHONE NUMBER:
DATE OF BIRTH :
COUNTRY OF BIRTH :
NATIONALITY :
COUNTRY OF DOMICILE :
PASSPORT NUMBER :
DATE OF EXPIRY :
HAVE YOU EVER PREVIOUSLY STUDIED IN THE UK?
(eg. degree programme, short course, Study Abroad.
If yes, please attach full details/transcript.)
YES ( NO (HAVE YOU EVER HELD A VISA FOR STUDY IN THE UK?YES ( NO (
___/___/____ If yes, give date of visa expiry and attach a
DD/MM/YYYY scanned copy to this formIF YOU ARE, OR HAVE BEEN, A STUDENT AT THIS UNIVERSITY, PLEASE STATE, IF POSSIBLE, YOUR STUDENT NUMBER :
__________________________
IF YOU ARE MAKING THIS APPLICATION WITH THE
ASSISTANCE OF AN AGENT OR EDUCATION ADVISER,
PLEASE GIVE THE AGENTS NAME AND DETAILS
COMPANY NAME: ____________________________________
CITY/COUNTRY: ____________________________________
EMAIL:
ENGLISH LANGUAGE QUALIFICATIONS
Please provide details and enclose scanned copy of certificate(s)
NAME OF TEST
(eg. IELTS, TOEFL ibt, O-Level)
RESULT/GRADE
(include component results if appropriate)DATE OBTAINED/
TO BE TAKEN
OFFICE USE ONLYDATEDECISION (and conditions if any)DATE OF RECEIPT
SCHOOL/COLLEGE EDUCATION
ATTENDANCE AND EXAMINATIONS AT SCHOOL/COLLEGE
NAME OF SCHOOL/COLLEGE
DATES (mm/yy-mm/yy)
SCHOOL/COLLEGE EXAMINATIONS (eg. IGCSEs, A-Levels, Edexcel, SPM, O-levels, IB, High School Diploma or
equivalent)
INCLUDE DETAILS OF EXAMINATIONS STILL TO BE TAKEN
TITLE OF
EXAM
(eg A-level)
DATE
TAKEN
(mm/yy)
SUBJECT AND
LEVEL
(if appropriate)
RESULT
OR
GRADE
TITLE OF
EXAM
(eg A-level)
DATE
TAKEN
(mm/yy)
SUBJECT AND
LEVEL
(if appropriate)
RESULT
OR
GRADENOTE: AN OFFICIAL TRANSCRIPT OF THE SCHOOL COURSES YOU HAVE COMPLETED, SHOWING THE GRADES OBTAINED, MUST BE INCLUDED WITH THIS APPLICATION. IF NECESSARY, INCLUDE AN OFFICIAL TRANSLATION INTO ENGLISH.
HIGHER EDUCATION
ATTENDANCE AND EXAMINATIONS AT THIS AND OTHER UNIVERSITIES
UNIVERSITY/COLLEGE
DATES (mm/yy-mm/yy)
DEGREE SUBJECT
SUBJECT
YEAR
RESULT
SUBJECT
YEAR
RESULT
NOTE: AN OFFICIAL TRANSCRIPT OF THE UNIVERSITY COURSES YOU HAVE COMPLETED, SHOWING THE GRADES OBTAINED, MUST BE INCLUDED WITH THIS APPLICATION. IF NECESSARY, INCLUDE AN OFFICIAL TRANSLATION INTO IN ENGLISH.
REFEREES
Please either include references with your application form, or provide details of your referees below
Give names and addresses of two referees, who should be associated with your school, university, college or professional institution, and should be familiar with your academic or professional work.NAME : POSITION : ADDRESS :POSTCODE:PHONE:EMAIL:
NAME : POSITION : ADDRESS :POSTCODE:PHONE:EMAIL:
OTHER INFORMATION, INCLUDING ANY RELEVANT PROFESSIONAL OR BUSINESS EXPERIENCE
Please provide any other information that you wish to be taken into account in support of your application (use continuation sheets if necessary).
DISABILITY/SPECIAL NEEDS (Please refer to notes below)
DO YOU HAVE ANY DISABILITY OR SPECIAL NEEDS?
If the answer is NO please use code A in the box provided.
If the answer is YES please use the appropriate code (see below) and give a brief description of your disability.
(
The Universitys policy is to view applications from disabled students on the same academic grounds as those applied to all candidates. It is essential, however, for the University to know about the degree of disability or special need in advance so that it may offer advice on what facilities or support may be available. Potential applicants who have a serious disability, long term condition or special need are advised to contact Disability Services (tel: +44 (0) 28 9097 2727) as soon as possible regarding their disability.
DISABILITY / SPECIAL NEEDS CODESANo disabilityBYou have a social/communication impairment such as Asperger's syndrome/other autistic spectrum disorderCYou are blind or have a serious visual impairment uncorrected by glassesDYou are deaf or have a serious hearing impairmentEYou have a long standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease, or epilepsyFYou have a mental health condition, such as depression, schizophrenia or anxiety disorderGYou have a specific learning difficulty such as dyslexia, dyspraxia or AD(H)DHYou have physical impairment or mobility issues, such as difficulty using your arms or using a wheelchair or crutchesIYou have a disability, impairment or medical condition that is not listed aboveJYou have two or more impairments and/or disabling medical conditions CRIMINAL CONVICTIONS see Note 6 below
DO YOU HAVE ANY CRIMINAL CONVICTIONS?
Please refer to the notes below. If you do not tick either the Yes or No box, we will return your form for completion. This will delay consideration of your application.
Yes(No(
DATA PROTECTION
In order to comply with the provisions of the Data Protection Act 2018 and the General Data Protection Regulation we will provide you with information about how we use, store and share your personal and sensitive data. In summary, the data collected is used as follows:
For the purposes of assessing your eligibility for admission as an undergraduate student and for funding (if applicable).
To contact your current and/or previous education provider(s) to ascertain exact marks achieved by you in your previous studies for the purposes of ranking your application in any competition(s) for funding at Queens University Belfast.
For other purposes as outlined in the Admissions and Access HYPERLINK "http://www.qub.ac.uk/directorates/MRCI/admissions/FairProcessingNotice/" Fair Processing Notice and in the HYPERLINK "http://www.qub.ac.uk/about/Leadership-and-structure/Registrars-Office/FileStore/Filetoupload,766524,en.pdf" Student Privacy Notice which you should read carefully.
DECLARATION
I confirm that the information given on this form is true, complete and accurate and no information requested or other relevant information has been omitted. I accept that if any information is inaccurate or has been omitted, if I do not provide a transcript (if applicable) or if it is considered by the University that any work I have submitted in support of my application is not my own, the University reserves the right to cancel my application or withdraw an offer of a place (if applicable) and I shall have no claim against the University in relation thereto.
( Yes, I understand and accept the above statement
If offered a place in due course I understand that, in accepting, I agree to abide by the rules and regulations of the University. By signing the application form I confirm my agreement to this.
SIGNATURE . DATE .
NOTES
1 This form is to be used by international applicants who wish to apply directly, and only, to Queens or who have been asked to provide information in advance of submitting a formal UCAS application. It should be returned to the Admissions and Access Service, Lanyon Building North, Queens University Belfast, Belfast, BT7 1NN as soon as possible. Applications may be scanned and emailed to HYPERLINK "mailto:intl.admissions@qub.ac.uk" intl.admissions@qub.ac.uk
2 If you have already submitted a UCAS application in the current admissions cycle (for entry either to Queens University Belfast or another institution), the UCAS number MUST be included in the appropriate box on page 1 of the form. If you subsequently submit a UCAS application you MUST include Queens as one of your choices and advise us of your UCAS personal ID as soon as it is known.
3 The application may be accompanied by a covering letter, if appropriate. To expedite your application, please include official transcripts of your academic background to date, including high school certificates, English language qualifications, and transcripts of university study if applicable. If necessary, please send official translations into English. Documents may be scanned and emailed to HYPERLINK "mailto:intl.admissions@qub.ac.uk" intl.admissions@qub.ac.uk
4 Before completing the form, applicants should acquaint themselves with the requirements for entry to the course, and with the regulations of the School at HYPERLINK "http://www.qub.ac.uk/home/StudyatQueens/InternationalStudents/" http://www.qub.ac.uk/home/StudyatQueens/InternationalStudents/
5 International (non-EU) students are required to produce evidence that they have made adequate financial provision for their maintenance and payment of fees. Enrolment may not take place until fees have been paid
6 CRIMINAL CONVICTIONS
You are requested to state whether or not you have any relevant criminal convictions except a motoring offence for which you have received a fine or three penalty points or a spent sentence (as defined by the Rehabilitation of Offenders Act 1974 / Rehabilitation of Offenders (NI) Order 1978), except for certain courses (see below).
Relevant criminal convictions are defined as criminal offences involving any kind of violence, including, but not limited to, threatening behaviour, offences concerning the intention to harm or resulting in actual bodily harm; the unlawful supply of controlled drugs or substances where the conviction concerns commercial drug dealing or trafficking, offences involving firearms, arson, or those listed in the Sexual Offences Act 2003 / Sexual Offences (NI) Order 2008 or the Terrorism Act 2006 / Terrorism (NI) Act 2006. Criminal offences include convictions, cautions, admonitions, reprimands, final warnings, bind over orders or similar.
Certain professions or occupations, particularly teaching, medicine, dentistry, law, accountancy, actuarial, healthcare, social work, pharmacy and professions or occupations involving work with children or vulnerable adults, including elderly or sick people, are exempt from the Rehabilitation of Offenders Act 1974 / Rehabilitation of Offenders (NI) Order 1978. When applying for any such courses you must tell us about any spent or unspent criminal convictions, including cautions, reprimands, final warnings, bind over orders, penalty notices, ASBOs or violent offender orders.
If you have not been convicted of a criminal offence, you must tick the No box. If you tick the Yes box the University may ask you to send more details. If your conviction involved an offence similar to those set out above, but was made by a court outside the United Kingdom, you should tick the Yes box.
If you do not answer this question we will contact you in writing and this will delay the processing of your application.
If you are not sure whether to tell us about a previous conviction, you can get more advice from a solicitor, but you may have to pay for this.
If you are convicted of a criminal offence after you have applied, you must tell us and provide details.
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