Undergraduate Application Form

Before completing this form, please ensure that you have read the guidance
notes thoroughly. Please complete in black ink using BLOCK CAPITAL LETTERS.

Section 1

ID

Personal details

Title (Mr/Mrs/Miss/Ms)

Surname/family name

Forenames (in full)
Preferred first name
Previous surname/family name (if applicable)
Gender

Male m

Female m

Date of birth

d d m m y y

Home/permanent address

Correspondence address (if different)

Postcode (UK only)

Postcode (UK only)

Country

Country

Telephone number

Mobile number

Fax number

Email address

Unique Learner Number

Section 2

Programme of study

Title of course applied for (e.g. BSc Biology)

Mode of study
Location

Full time m

Part time m

Distance learning m

Start date m

m y y

Campus-based m

Point of entry

Campus

Alternative choice

Have you studied at the University of Portsmouth previously?
If yes, which course(s)?

Section 3

Yes

m

Year of leaving

Residence

Nationality (as stated in your passport)

Country of birth

Area of permanent residence

Nationality of parent(s)

Residential category (please refer to guidance notes)

No

m

Student number

Disability/ special needs Do you have a disability or a medical condition that might require special arrangements or facilities? DSA Will you be in receipt of Disabled Student’s Allowance (DSA)? Yes m No m Care Have you been in care? Yes m No m Parental education Do any of your parents.Section 4 Non-UK nationals Date of first entry to live in the UK Have you been granted Indefinite Leave to Enter or Remain? d d m m y y Do you have Leave to Enter/Remain under a Tier 4/General student visa? If yes. please enter the code that best describes your own socio-economic background. If you are 21 or over. listing your current/most recent studies first. please enter the relevant code for the length of time you have been in care No m I don’t know m I prefer not to say m Socio-economic Please enter the code that best describes the socio-economic background of the highest-earning background family member of the household in which you live. college or university you attended or are currently attending. The information will be used for statistical purposes only and will not be used as part of the selection process. Section 6 Criminal convictions If you have a relevant criminal conviction please tick the box (please refer to guidance notes) Section 7 m Funding Please enter the code that describes your proposed means of financial support Section 8 Previous education Please provide details of the school. Name of institution From To Month Year Month Year . step-parents or guardians have any Higher Education qualifications? Yes m Previous qualification Please enter the code that describes the highest academic qualification you have achieved. Ethnic origin Please enter the code that best describes your ethnic origin. If yes. visa issue date Visa expiry date Passport number Passport issue date Passport expiry date Passport place issued Student visa required? Yes m No Yes m No m Yes m No m m Name of home university/institution Section 5 Equal opportunities monitoring (please refer to guidance notes) The University of Portsmouth is committed to a policy of equal opportunities. The details you provide will help us monitor the effectiveness of this policy. please enter the relevant code Yes m No m If yes.

please give details. Date taken Month Year Awarding body Level/ qualification Subject/unit/module/component Result. IELTS: Overall score TOEFL: Computer-based Reading Cambridge Test: Other: Listening Writing Speaking Paper-based Internet-based Date Advanced score Proficiency score Date Title Score If you are planning to take an English language test. Test to be taken Have you been educated in English? Section 12 Name of employer Date Yes m No m Date Approximate date to be taken If yes. Date of results Month Year Awarding body Section 11 Level/ qualification Subject/module/component English language proficiency If English is not your first language. grade.Qualifications completed or certified Section 9 Examinations or assessments for which results are known. Please list most recent qualifications first. including those failed. mark or band Qualifications not yet completed Section 10 Examinations or assessments to be completed. please tell us about any English language qualifications you hold and provide original or certified copies of your English language certificates with your application form. or results not yet published. please state number of years Employment and work experience Job title Main responsibilities Dates of employment From To .

parent/guardian/adviser. in accordance with the provisions of the Data Protection Act 1998. it may be possible for your application to be considered for a programme offered by our partner college – International College Portsmouth (ICP).port. Please refer to the guidance notes for further assistance. please tick here. I agree to abide by the University’s rules and regulations. Note that your application will not be processed without a personal statement. Full name of nominee Section 16 Relationship to you International applicants only In the event that we are unable to offer you a place. the offer may be withdrawn.Section 13 Reference (please refer to guidance notes) The University requires one reference in support of your application. We are unable to make a decision about your application until we receive your reference. If the University of Portsmouth discovers that I have made a false statement or have omitted significant information from my application form. If accepted onto a programme of study.uk University House Web: www. the information given on this form is true. Section 15 Nominated access If you would like to nominate someone. who can discuss your application with us if you are unavailable. e. If you are happy for us to forward your application form to ICP for consideration.uk Winston Churchill Avenue Portsmouth PO1 2UP United Kingdom PS5181 0112 . Name Position Address Telephone number Email address Section 14 Personal statement Please write a personal statement on a separate sheet (provided) to support your application to study on this course.ac.ac. m Section 17 Declaration I confirm that. to the best of my knowledge and belief. both internally and externally and that the University may also check the information provided with any previous educational establishment I have attended and with the Immigration Service. I accept that the information given on this form will be retained by the University and used for the purpose of processing my application. please provide details below. Please provide details of your referee below and send the enclosed reference request sheet on to your referee as soon as possible. Signature Date d d m m y y Please return your completed application together with evidence of your academic qualifications and your reference to: Admissions Telephone: +44 (0)23 9284 8484 Academic Registry Fax: +44 (0)23 9284 3082 University of Portsmouth Email: admissions@port. complete and accurate. I understand that the information stored by the University of Portsmouth may be used for reporting. I understand that any offer of a place at the University of Portsmouth will be based upon the information given in this form. Please note that it is your responsibility to contact your referee.g.

Undergraduate Guidance Notes The following notes relate to the numbered sections in the application form and are intended to help you complete the form. If the course you are applying for is taught on a campus outside of Portsmouth (e. Previous surname/family name If you have changed your name since your 16th birthday. 9 Other: You do not fit into any of the above categories. but not just for full-time education. or are the child or grandchild. Please keep the University informed of any change to your current email address. If we are able to contact you by email any queries we have about your application can be resolved faster. 3 Child of a Turkish worker: You are the child of a Turkish national who has lawfully worked in the UK. e. If you would prefer correspondence to be sent to a different address. If not. . Have you studied at the University of Portsmouth previously? If you have studied at the University of Portsmouth previously please tick the ‘Yes’ box and provide details in the spaces provided. please complete the section ‘Correspondence address’. civil partner or child under 18 of such a person at the time of the asylum application. Residential category This section helps to establish the level of tuition fees (home or overseas) that you will be charged if you are offered a place. your application could be delayed. Humanitarian Protection or Discretionary Leave or you are the spouse. England. Switzerland or Overseas Territories (OT) for the past three years. International students: The UK Border Agency (UKBA) requires all institutions to provide evidence of student’s ‘academic progression’. For example. please leave this section blank. The category that you choose is provisional. You have lived in the EEA or Switzerland or OT for the past three years. and have lived in the European Economic Area (EEA). but not just for full-time education. If you do not have a ULN. if you already have an undergraduate degree that is equivalent to a UK undergraduate degree you MUST be applying for Master’s level study). Location Please tick whether you wish to study via distance learning or be taught on campus. Section 3 Residence Nationality Please enter your nationality as stated in your passport. Preferred first name If you have a different name you would rather be known by. Area of permanent residence Please enter your permanent country of residence. 6 Settled in the UK: You have Indefinite Leave to Enter or Remain in the UK or have the Right of Abode in the UK and have lived in the UK. Address Your Home/permanent address is the address where you usually live. e. please specify the country. please leave this section blank. Point of entry Please enter the year of entry for which you are applying. Unique Learner Number Enter your ten-digit Unique Learner Number here. Your alternative choice will only be considered if we are unable to offer you a place for your first choice. 2 EEA or Swiss national: EITHER: You are an EEA or Swiss national working in the UK. please enter your previous surname or family name. The University will make the final decision on your category and may request additional information from you if there is a query about the information you have provided. This means that all students applying to study must be applying for a course that is above their current academic level (for example. Using the category definitions and notes below please select the residential category which you think applies to you and enter the code in the box provided. Year 1. surname and forename(s) exactly as they appear on official documents such as examination certificates. Alternative choice Please enter the exact course title as specified in the University prospectus or website. If you have dual nationality.g. use the contact details on the application form. 4 Refugee: You have been recognised as a refugee by the British government or you are the spouse. your proper name is Andrew but you are known as Andy. This will help the University when checking your educational records. spouse or civil partner of such a person or you are the parent or grandparent of an EEA national working in the UK.g. and you have lived in the EEA.g. OR: You are the child of a Swiss national and have lived in the EEA or Switzerland or OT for the past three years. or you are the child. Section 2 Programme of study Title of course applied for Please enter the exact course title as specified in the University prospectus or website. but not just for full-time education. the Channel Islands or the Isle of Man (or more than one of these) for three years. civil partner or child under 18 of such a person at the time of the asylum application. Chichester College). please enter both. Several courses have similar names and if we need to clarify these details at a later stage. passport or driving licence. please specify the campus here. Section 1 Personal details Surname/family name/forenames Please enter your title. Email address Please enter your personal email address. or the spouse or civil partner of a UK or EU national. Switzerland or Turkey for the past three years. 5 Humanitarian Protection or similar: You have been granted Exceptional Leave to Enter or Remain. If you have any questions relating to this or need further advice. Please ensure that you have read them thoroughly before completing your application. but not just for full-time education. If your permanent home is in the UK. 1 UK Citizen or EU national: You are a UK or EU national. It is essential that you inform the University if your correspondence address changes. please enter it here.

If your category code is ‘9’. Section 4 Non-UK nationals Date of first entry to live in the UK If you were born outside the UK. such as difficulty using your arms or using a wheelchair or crutches. or epilepsy. diploma or certificate of higher education. You have physical impairment or mobility issues. You have a social/communication impairment such as Asperger’s syndrome/other autistic spectrum disorder. The date should be found in your passport or other papers used to gain admission to the UK. step-parents or guardians have themselves undertaken a course at higher education level. diabetes. schizophrenia or anxiety disorder. your spouse. special needs or a medical condition. please contact Academic Registry immediately as your residential category may be reconsidered. please tick ‘No’. your spouse or civil partner or either of your parents are later granted refugee status. Humanitarian Protection or Discretionary Leave. college or institution that you are currently attending. You have a mental health condition. If your category code is ‘9’. 2. but you. You have a disability. You have a long standing illness or health condition such as cancer. special needs (including dyslexia or another specific learning difficulty) or a medical condition. impairment or medical condition that is not listed above. If you do not have a disability. The information you provide in this section will not influence the assessment of your application. Do not give a date if you are staying in the UK on a temporary basis. The University is required to release this information to the Higher Education Statistics Agency to whom all UK universities are legally obliged to report data. such as a degree. Traveller or Irish Traveller 33 Asian – Bangladeshi 21 Black – Caribbean 34 Asian – Chinese 22 Black – African 39 Other Asian background 29 Other Black background 41 White and Black Caribbean 31 Asian – Indian 42 White and Black African 43 49 50 80 90 98 White and Asian Other Mixed background Arab Other Ethnic background Not known I prefer not to say Disability/special needs If you have a disability. A B C D E F G H I J No disability. Ethnic origin Please read the list below and enter the code that best describes your ethnic origin. Care If you have not spent time in care please tick the ‘No’ box. please contact Academic Registry immediately as your residential category may be reconsidered. for example for the purpose of study. Student visa required? If you need a student visa to study in the UK. You have two or more impairments and/or disabling medical conditions. please tick the ‘Yes’ box and select the most appropriate code from the list below. please tick the ‘Yes’ box and indicate how long you were in care: A Less than one week C Three months to one year E Three years or more B One week to three months D One year to three years Parental education Please indicate whether or not any of your parents. semi-independent living or residential care homes. please contact Academic Registry immediately as your residential category may be reconsidered. dyspraxia or AD(H)D. You are blind or have a serious visual impairment uncorrected by glasses. 3. your civil partner or either of your parents are later granted EU citizenship. HIV. Name of home university/institution Provide the name of the university. but you are granted British citizenship or Indefinite Leave to Remain after the date of your application. Section 5 Equal opportunities monitoring This information will be used by the University for statistical purposes only and will not affect the decision on your application. but now live here please give the date when you began to live here permanently.Notes 1. If you have spent any time in local authority care. 11 White 32 Asian – Pakistani 16 Gypsy. You are deaf or have a serious hearing impairment. but you. tick ‘No’. chronic heart disease. Have you been granted Indefinite Leave to Enter or Remain? If you have been granted Indefinite Leave to Enter or Indefinite Leave to Remain please tick the ‘Yes’ box. You have a specific learning difficulty such as dyslexia. . If you do not need a student visa. such as depression. If your category code is ‘9’. tick ‘Yes’. including if you have been in public care and had lived in one or more of foster care.

Do not send details of the offence. please tick the box. you should tick the box.e. anti-social behaviour orders (ASBOs) or violent offender orders (VOOs) are not classed as convictions for the purpose of this section. If you are convicted of a relevant criminal offence after you have applied. c Offences involving firearms. c Offences listed in the Sex Offences Act 2003. colleges or universities you have attended. The University will then ask you for more details. c Offences listed in the Terrorism Act 2006. Section 7 Funding Please enter the appropriate code to show how you intend to finance your studies. If you have a relevant criminal conviction. SAAS. their conviction becomes ‘spent’ (as defined by The Rehabilitation of Offenders Act 1974). The information that you provide will not affect the academic assessment of your application. EU. If you are an international student. Chl. However the University may want to consider the application further or ask for more information before making a decision. and that conviction would not be considered as spent under the Rehabilitation of Offenders Act 1974. 1 Higher managerial and professional occupations 2 Lower managerial and professional occupations 3 Intermediate occupations 4 Small employers and own account workers 5 Lower supervisory and technical occupations Section 6 Foundation degree Diploma of Higher Education (DipHE) Higher National Diploma (HND) Foundation course at level J Certificate in Education (CertEd) or Diploma in Education (DipEd) (i. Warnings. but was made by a court outside of Great Britain. 01 02 04 05 Private finance SLC. simply tell us that you have a relevant criminal conviction. non-graduate initial teacher training qualification) Other qualification at level J Certificate of Higher Education (CertHE) Higher National Certificate (HNC) Higher Apprenticeship (level 4) Other qualification at level C Undergraduate credits Diploma at level 3 Certificate at level 3 Award at level 3 AQA Baccalaureate (Bacc) A/AS level 14–19 Advanced Diploma (level 3) Scottish Baccalaureate International Baccalaureate (IB) Diploma 6 7 8 9 P63 P64 P65 P68 P80 P91 P92 Q51 Q52 Q80 R51 R52 R80 X00 X01 X02 X06 International Baccalaureate (IB) Certificate Cambridge Pre-U Diploma Cambridge Pre-U Certificate Welsh Baccalaureate Advanced Diploma Other qualification at level 3 Level 3 qualifications of which some or all are subject to UCAS Tariff Level 3 qualifications of which none are subject to UCAS Tariff 14–19 Higher Diploma (level 2) Welsh Baccalaureate Intermediate Diploma Other qualification at level 2 14–19 Foundation Diploma (level 1) Welsh Baccalaureate Foundation Diploma Other qualification at level 1 Higher education (HE) access course (QAA) Higher education (HE) access course Mature student admitted on basis of previous experience and/or admissions test Not known Semi-routine occupations Routine occupations Never worked and long-time unemployed Not classified Criminal convictions To help us ensure that the interests and safety of all members of the University community are safeguarded. What does ‘spent’ mean? If a person does not re-offend during their rehabilitation period. we must know about any relevant criminal convictions that an applicant may have. please tick the box. If your conviction involved an offence similar to those set out above. What is a relevant criminal conviction? Relevant criminal offences include convictions. otherwise leave it blank. penalty notices for disorder (PNDs). You should note that certain offences are never spent. NIBd. you must tell us. bind over orders or similar involving one or more of the following: c Any kind of violence including (but not limited to) threatening behaviour. final warnings. DUK UK doctorate degree DZZ Non-UK doctorate degree D80 Other qualification at level D MUK UK Master’s degree MZZ Non-UK Master’s degree M2X Integrated undergraduate/postgraduate taught Master’s degree on the enhanced extended pattern M41 Diploma at level M M44 Certificate at level M M71 PCE or PGDE M80 Other taught qualification at level M M90 Taught work at level M for institutional credit HUK UK first degree with honours HZZ Non-UK first degree H11 First degree with honours leading to Qualified Teacher Status (QTS)/registration with a General Teaching Council (GTC) H71 PGCE H80 Other qualification at level H JUK UK ordinary (non-honours) first degree J10 J20 J30 J49 J48 J80 C20 C30 C44 C80 C90 P41 P42 P46 P47 P50 P51 P53 P62 Socio-economic background Please select from the list below. IoM Research Council DH/Regional health Section 8 06 07 08 09 UK Government international award Training agency Other UK Government award International agency 10 90 99 UK industry/commerce Other source Not known Previous education Please use this section to provide details of up to ten of the most recent secondary schools. reprimands.Previous qualification Please enter the appropriate code to indicate the highest academic qualification you have achieved. . If you have a relevant criminal conviction that is not spent. offences concerning the intention to harm or offences which resulted in actual bodily harm. Please list your current/ most recent studies first. cautions. admonitions. unless you have contested a PND or breached the terms of an ASBO or VOO and this has resulted in a criminal conviction. c Offences involving arson. c The unlawful supply of controlled drugs or substances where the conviction concerns commercial drug dealing or trafficking. Convictions that are spent are not considered to be relevant and you should not reveal them. on entry to the UK you will have to demonstrate that you have sufficient funds to pay for your fees and support yourself throughout your studies.

only qualifications achieved in the last two years will be accepted as evidence of current language proficiency. If you are an international student you may also like to include the following: c Why you wish to study in the UK. Section 13 Reference The University requires one reference in support of your application to help assess your suitability for your chosen course. University House. placement or voluntary work you have done. Please note that it is your responsibility to contact your referee. Sutton Trust. You may want to include the skills and experience you have gained from these activities.ac. e.g. If you have any questions about the status of your application please contact the relevant faculty admissions office. Please email: admissions@port. Section 10 Qualifications not yet completed Please list all qualifications for which you are currently studying or for which you are awaiting examination results. The reference should be returned to you in a sealed envelope which you should forward (unopened) to Academic Registry with your application. We are unable to make a decision about your application until we receive your reference.ac. other relatives or friends. LEAPS or ASPIRENorth. However.ac. other relative or guardian. Section 14 Personal statement Please write a statement to support your application to study on this course. NAGTY. This could be an employer. for example on a gap year.uk The University will acknowledge receipt of your application by email. or a senior colleague in employment or voluntary work. the University will require you to achieve a satisfactory score in an approved English Language qualification. If your application is unsuccessful we will provide feedback on request. your reasons why. Please say if some of your studies have been assessed in English. University of Portsmouth. Section 11 English language proficiency If your first language is not English. you should ask a responsible person who knows you to provide your reference. training officer. paid or unpaid. work experience.uk   Web: www. c Your social. copies of certificates or transcripts).ac. We usually aim to make a decision on your application within four weeks. Winston Churchill Avenue. We suggest you include some or all of the following points: c Your reasons for choosing the course. Please send your referee this sheet as soon as possible. your application will be delayed until all your documents have been received. you may need to provide original or certified copies of your documentation at a later stage. Photocopies are sufficient at application stage. careers adviser.admissions@port. Section 9 Qualifications completed or certified Please list all qualifications for which you have accepted certification from an awarding body. a parent. a teacher on a recent relevant further education course. c Details of any non-examination based activities you have undertaken in preparation for higher education such as AimHigher. even if you are retaking all or part of the qualification. giving a brief description of the nature of your work and responsibilities. c What interests you about your chosen subject. In general. you should give details of any relevant work experience. or whoever may be helping you with your application. sports or leisure interests. Please provide original or certified copies of your English language certificates with your application form. If you are using an agent. you can choose to enter their details. We are unable to accept references from family. c How your programme choice fits with your future career plans. If you are not in full-time education.uk/undergradadmissions.ac. Please enclose evidence of your academic qualifications with your application (e.g. Academic Registry.uk. Submitting your application When you have completed your application form please return it.port. Section 17 Declaration Please read the declaration carefully. GOALS. you may wish to nominate someone who can make decisions on your behalf and discuss your application with us. please speak to your school or college. Your application will then be passed to the appropriate department for consideration. International applicants should contact our International Admissions team at international. Please list the name and contact details for your referee in the spaces provided. c What evidence you have to show that you can complete a higher education course that is taught in English. particularly if it is relevant to your subject. A separate reference request sheet is included with the application form. Your reference should be given by one of your teachers/tutors or by someone who is able to comment on your academic ability as well as your potential to succeed on your chosen programme of study. PS5182 0112 .port. Section 15 Nominated access If you are likely to be away at any time during the application period. If you have any queries about entering your qualifications. United Kingdom Telephone: +44 (0)23 9284 8484   Fax: +44 (0)23 9284 3082   Email: admissions@port. If you are not in full-time education. If you have already taken or are planning to take an English language test please give details in the spaces provided. c If you are planning to take a year out. If your employment/work experience is relevant to your proposed programme of study you may wish to include further details in your personal statement. Your referee should know you well enough to write about you and to comment whether you are suitable for higher education. and information about your current or previous employment. c Any job. Portsmouth PO1 2UP. together with evidence of your academic qualifications and your reference to: Admissions. then sign and date the form. Contact details are available at www. Please note that if you have not submitted all the required documentation.uk. Section 12 Employment and work experience Please provide details of any employment or work experience to support your application.

BSc Biology): Please enter your details above and pass this form to your referee. If relevant.g. c Any supplementary information about their qualifications and study which they have not already described in their application (if known). c If the applicant’s first language is not English. your opinion on their suitability for this career path. c Existing achievement. PS2145 1207 . Please pass this envelope to the applicant who will forward your reference to the University. Once you have completed your reference please attached it securely to this form. Please forward the envelope (unopened) to Academic Registry with your application. c Any commitments that might prevent the applicant from going to an interview on a particular day. please indicate their standard of written and spoken English. Academic Registry. Please be aware that under the provisions of the Data Protection Act 1998. Portsmouth PO1 2UP. c Relevant curriculum enrichment and related skills such as work experience and voluntary work. University House. If you have already submitted your application please send the reference to Admissions. Please supply your reference on your company’s/institution’s official headed paper. We should be grateful if you could enter your details below and provide us with a reference on the applicant’s suitability to undertake the proposed programme of study. If your organisation has an official stamp or seal please use it to authenticate the reference. with particular reference to subjects relating to the course(s) for which they are applying. c Proposed career ambitions. c Involvement in widening participation. motivation and commitment. Name of referee Position Address Telephone number Email address Signature Date d d m m y y It would be of great assistance if you could include the following information in your reference: c Length of time that you have known the applicant and in what capacity. You should ask for the reference to be returned to you in a sealed envelope. Winston Churchill Avenue. Gifted and Talented initiatives or Partnerships for Progression. To the applicant Section A Title (Mr/Mrs/Miss/Ms) Surname/family name Forenames (in full) Date of birth d d m m y y Title of course applied for (e. Section B To the referee The person named above has submitted an application for undergraduate study at the University of Portsmouth and has named you as a referee. University of Portsmouth. attitude. United Kingdom. place it in an envelope and seal it. we may be required to make the contents of our applicant files (including any references) available for inspection by the individual concerned.Undergraduate Reference Request Please complete in black ink using BLOCK CAPITAL LETTERS.

work experience. placement or voluntary work you have done. Please write a statement to support your application to study on this course. paid or unpaid. We suggest you include some or all of the following points: c your reasons for choosing the course c what interests you about your chosen subject c any job. LEAPS or ASPIRENorth If you are not in full-time education. Please say if some of your studies have been assessed in English Title (Mr/Mrs/Miss/Ms/Dr) Surname/family name Forenames (in full) Course applied for Please write your statement here and continue overleaf or on a separate sheet if necessary. you should give details of any relevant work experience. and information about your current or previous employment. If you are an international student you may also like to include the following: c why you wish to study in the UK c what evidence you have to show that you can complete a higher education course that is taught in English. particularly if it is relevant to your subject. You may want to include the skills and experience you have gained from these activities c how your programme choice fits with your future career plans c if you are planning to take a year out.Personal Statement Please return this completed form together with your completed application form. NAGTY. Sutton Trust. PS5195 0112 . GOALS. your reasons why c your social sports or leisure interests c details of any non-examination based activities you have undertaken in preparation for higher education such as AimHigher.