POSTGRADUATE APPLICATION FORM

Grad. Dip ⃞ MA ⃞ Full-time ⃞

PG Dip ⃞ MSc ⃞ Part-time ⃞
PG Cert ⃞ MBA ⃞
Diploma ⃞
Month of Entry_____________

COURSE TITLE:

PERSONAL DETAILS

Family name:

Title:

Forename (in full):

Preferred name:

Date of birth:

Gender:

Nationality:

Country of permanent residence:

Country of birth:

Highest Qualification:

Passport No. (ALL International):

Contact details
Home address: Correspondence address:

Home Tel: Mobile:

E-mail address:

Please tick which address you wish us to use: Home ⃞ Correspondence ⃞

Who will pay your fees? SELF ⃞ OTHER ⃞ (please specify):

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PREVIOUS STUDY AND QUALIFICATIONS
Please list in chronological order all academic studies completed, whatever the result, plus any studies currently being pursued. Please attach a certified copy of your certificates and transcripts of all grades obtained.

From To Language of PT
Month/Year Month/Year Qualification (to be) obtained and major subject Institution of study Country of study FT
instruction

PAST EMPLOYMENT HISTORY

This section is for brief details about your past employment history. Please include any part-time, casual and voluntary work undertaken (in reverse chronological order)
From To Organisation – Name, address, phone
Post title Brief description of post/duties FT PT
Month/Year Month/Year number

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 CURRENT EMPLOYMENT
Post title:

Date commenced:
Organisation name, address & telephone number:

Details of the post:

MEMBERSHIP OF PROFESSIONAL INSTITUTIONS (if applicable)

Start date of Expiry date of
Organisation Level of membership Registration No.
membership membership

CANDIDATE’S STATEMENT and LETTER OF APPLICATION

Please attach on separate sheets, information relevant to and/or in support of your application. Include
information such as: personal qualities, life experiences, relevant courses, other prior learning experiences not
referred to elsewhere on the form.
Please also comment on why you are applying for this specific programme. Include here any health or personal
factors which you deem should be known to the University when considering your application.
Counsellor Supervision Diploma only: Present your theoretical approach to counselling. Explain the basic
principles of this approach and give examples of the approach in use in your counselling practice. Make
appropriate reference to the counselling literature. Finally, give your reasons for wishing to take the course and
what attracts you about the programme.
Minimum of 1,000 words
Leadership & Management MA

Maximum of 500 words

MBA
International Business MA/PG Dip/PG Cert
Global Marketing MA/PG Dip/PG Cert

Maximum of 1,000 words

For all other programmes.

DECLARATION
Applicants should note that the University is not obliged to provide explanations as to the reasons for accepting or
rejecting any particular application.

CONFIDENTIALITY: Applications will be treated in the strictest confidence by the University, and the information
given will be used only for the following purposes:
(a) to enable the University to give full and proper consideration to applications, and
(b) for the compilation of essential statistics.

In accordance with the provisions of the 1984 Data Protection Act, no statistical or other information which could
identify any individual applicant will be published or otherwise communicated to any other agency.

I certify that all the entries are, to the best of my knowledge and belief, correct, and I undertake, if
admitted, to observe the regulations of York St John University.

Signature________________________________ Date___________________

Equal Opportunities Form

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Do you have any criminal convictions? YES ⃞ NO ⃞
Please tick Yes or No depending if you have or have not got a relevant criminal conviction. Relevant convictions are only those convictions for
offences against the person, whether of a violent or sexual nature, and convictions for offences involving unlawfully supplying controlled drugs or
substances where the conviction concerns commercial drug dealing or trafficking. Convictions that are spent (as defined by the Rehabilitation of
Offenders Act 1974) are not considered relevant and you should not reveal them. If you circle yes, you will not be automatically excluded from the
application process, however we may ask you for more information. You should be aware that for courses in teaching, health or a course involving
work with children or vulnerable adults, any criminal convictions, including sentences and cautions (including verbal cautions), reprimands, final
warnings and bind-over orders are exempt from the Rehabilitation of Offenders Act 1974. If you are applying for these courses we will ask you to
agree to have a criminal record check. If you are convicted of a relevant criminal offence after you have applied, you must tell York St John
University. Do not send any details of the offence, simply state that you have a relevant criminal conviction; we may then ask you more details.

Disability/Special needs
Please enter the appropriate code from the list below: ___
A No disability
You have a social/communication impairment such as Asperger’s syndrome/other autistic spectrum
B disorder
C You are blind or have a serious visual impairment uncorrected by glasses
D You are deaf or have a serious hearing impairment
You have a long standing illness or health condition such as cancer, HIV, diabetes, chronic heart
E disease, or epilepsy
F You have a mental health condition, such as depression, schizophrenia or anxiety disorder
G You have a specific learning difficulty such as dyslexia, dyspraxia or AD(H)D
You have physical impairment or mobility issues, such as difficulty using your arms or using a
H wheelchair or crutches
I You have a disability, impairment or medical condition that is not listed above
J You have two or more impairments and/or disabling medical conditions
In Care
Have you been in care? YES ⃞ NO ⃞ PREFER NOT TO SAY ⃞
If YES please state the length of time you were in care for: ___ yrs ___mths

Ethnicity
Please enter the appropriate code from the list below: ___
10 White 34 Chinese
21 Black or Black British - Caribbean 39 Asian Other
22 Black or Black British - African 41 Mixed - White and Black Caribbean
29 Black Other 42 Mixed - White and Black African
31 Indian 43 Mixed - White and Asian
32 Pakistani 49 Other Mixed background
33 Bangladeshi 80 Other Ethnic background
Parental education
Do any of your parents have any higher education qualifications such as a degree, diploma or
certificate of higher education?
YES ⃞ NO ⃞ DON’T KNOW ⃞ PREFER NOT TO SAY ⃞

DECLARATION SIGNATURE

I certify that all the entries are, to the best of my knowledge and belief, correct.

Signature________________________________ Date__________________

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MARKETING INFORMATION

We would welcome your responses in this section.

Information on your application to York St John University is helpful for our programme marketing. Any information
that you provide will only be used internally and will not affect the outcome of your application.

Please list, in order of preference with 1 ranking first, any institutions to which you have made an application,
including York St John.

1) …………………………………………………………

2) …………………………………………………………

3) …………………………………………………………

4) …………………………………………………………

Were you recommended to York St John by a former student?

Yes ⃞ No ⃞

If yes, who? ………………………………………………………………………

Please indicate the first and second most important sources of information, using the numbers 1 and 2 which
influenced you in applying for a postgraduate place at York St John University. Any additional information you can
give us would be helpful.

Press Advert/Article
⃞ ……………………
Recommendation from student
⃞ ……………………
Programme leaflet
⃞ ……………………
University prospectus
⃞ ……………………
University poster
⃞ ……………………
University website
⃞ ……………………
Careers office
⃞ ……………………
British Council
⃞ ……………………
Postgraduate fair
⃞ ……………………
Recommendation from employer/colleague
⃞ ……………………
Recommendation from tutor/academic
⃞ ……………………
Other
⃞ ……………………
Agents name and address (if applicable)

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ENGLISH LANGUAGE SKILLS AND QUALIFICATIONS

If your first language is not English, please indicate your proficiency by completing the sections below.

What is your first language? ________________________________

How often do you use English in a work context?

Daily ⃞ Weekly ⃞ Infrequently ⃞ Rarely ⃞ Never ⃞
How often do you use English in a study context?
Daily ⃞ Weekly ⃞ Infrequently ⃞ Rarely ⃞ Never ⃞
Competence in reading, speaking and writing in English is important; we therefore ask that you
demonstrate competence in English by answering the following.
You have been educated entirely in an English-speaking country for at least 1 year: ⃞
You will be taking a recognised English language test (for example, IELTS, TOEFL): ⃞
PLEASE INDICATE THE DETAILS OF YOUR ENGLISH LANGUAGE TEST:
IELTS Score
Speaking
Listening
Writing
Reading
Overall
Date of test

TOEFL Score
Computer
Paper
Date of test

TOEFL Internet Based (iBT) Score

Listening
Structure/Writing
Reading
Overall
Written English test
Date of test

Other (CAE/CPE/PTE etc) Score/Grade

Date of test

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 CHECKLIST

Please enclose the following with your application, if possible or submit these as
soon as possible otherwise your form may not be considered.

Please tick if you have enclosed:

Application form

Letter of application/candidate statement

One equal opportunities form

Academic transcripts
(in both original language and certified translation into English where
applicable)

English Language test results (if applicable)

Copy of Passport (ALL international Students)

Marketing information sheet

Graduate Diploma Psychology ONLY:

Academic transcript from your undergraduate degree.

Counsellor Supervision ONLY:

Counselling experience sheet

THE COMPLETED FORM SHOULD BE RETURNED TO:

Admissions
York St John University
Lord Mayor’s Walk
York
YO31 7EX United Kingdom

T: +44 1904 624624

F: +44 1904 872512
e: admissions@yorksj.ac.uk

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Reference
You are required to submit references from two referees. Your referees should ideally be someone able to
comment on any experience or qualifications shown on the application form.

Note to referee: You may continue on a separate sheet if necessary. Please return your reference to the applicant
in a sealed envelope, with a signature over the seal, to be forwarded with their application.

Counselling courses only: If you have recently undertaken or are currently undertaking a counselling training
course, please include your course tutor as one referee
Counsellor Supervision only: One of these should be your current Supervisor and one should be involved in the
counselling profession.
Name of applicant (block capitals or type only):

Name of referee:
Post/occupation:
How long have you known the applicant?
Relationship to applicant:
Address:

Tel:
E-mail:
Fax:
Please comment on the candidate’s motivation and intellectual capacity, and his/her
aptitude and potential for postgraduate study including their abilities and motivation
to work as part of a group and individually

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 Details of relevant work experience

If the candidate has been employed by you, a brief description of their duties and
standard of work including their abilities and motivation to work as part of a group and
individually

Additional information

Referee’s signature________________________Date__________________

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Reference
You are required to submit references from two referees. Your referees should ideally be someone able to
comment on any experience or qualifications shown on the application form.

Note to referee: You may continue on a separate sheet if necessary. Please return your reference to the applicant
in a sealed envelope, with a signature over the seal, to be forwarded with their application.

Counselling courses only: If you have recently undertaken or are currently undertaking a counselling training
course, please include your course tutor as one referee
Counsellor Supervision only: One of these should be your current Supervisor and one should be involved in the
counselling profession.

Name of applicant (block capitals or type):

Name of referee:
Post/occupation:
How long have you known the applicant?
Relationship to applicant:
Address:

Tel:
E-mail:
Fax:
Please comment on the candidate’s motivation and intellectual capacity, and his/her
aptitude and potential for postgraduate study including their abilities and motivation
to work as part of a group and individually

56857059.doc 10
 Details of relevant work experience

If the candidate has been employed by you, a brief description of their duties and
standard of work including their abilities and motivation to work as part of a group and
individually

Additional information

Referee’s signature________________________Date__________________

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