UCL APPLICATION FOR ADMISSION AS A GRADUATE STUDENT

APPLICANTS ARE ADVISED TO READ THE GUIDANCE NOTES BEFORE COMPLETING THE FORM. USE BLACK INK, BLOCK CAPITALS AND TICK BOXES AS APPROPRIATE. PERSONAL DETAILS FOR OFFICE USE

1. Surname/Family Name

2. First Names

3. Title (Mr/Mrs etc.)

4. Date of Birth
DAY MONTH YEAR

5. Sex ()
MALE FEMALE

6. Nationality

7. Country of Ordinary Residence

Applic. No. Date of Receipt

8. Home Address

9. Correspondence Address (if different)

H/O/E/X Postcode
PLEASE DETACH APPLICATION FORM BEFORE SENDING

Postcode Tel Fax E-mail Dates when address is valid Initials

FROM: TO:

Tel Fax E-mail

PROGRAMME OF STUDY FOR WHICH YOU WISH TO APPLY

10. UCL Department/Institute

11. Qualification Sought (MA, MSc, etc.)

12. Research Subject Area/Taught Programme Title

13. Method of Study ()

FULL-TIME PART-TIME (where available)

14. Proposed Starting Date

MONTH YEAR

15. Name(s) of proposed supervisor(s), if known (MPhil/PhD, MD(Res) only)

Taught programmes usually start in September or early October. Research students may begin in September, January, April or July, subject to departmental approval. If there is an alternative programme for which you also wish to be considered, you must send a photocopy of your application and all supporting papers (except those in sealed envelopes) substituting the alternative details in this section.
FOR OFFICE USE. TO BE COMPLETED BY THE GRADUATE ADVISER/DEPARTMENTAL ADMISSIONS TUTOR AND RETURNED WITH ALL APPLICATION PAPERS TO ADMISSIONS, ROOM G1, SOUTH WING

Name of Tutor Departmental Action ()

ACCEPT (PLEASE COMPLETE BOXES BELOW)

Signature Admissions to send standard letter? ()

REJECT YES NO

Date

WITHDRAWN

1. Qualification (MA, MSc, etc.)

2. Research Subject Area/Taught Programme Title

3. Method of Study ()
FULL-TIME PART-TIME FLEXIBLE

4. Start Date (if not September)

MONTH YEAR

5. Research Duration
YEARS MONTHS

6. Fee Rate* ()
SCIENCE CLINICAL

*only for research in clinical sciences

7. Principal UCL Supervisor

8. Subsidiary UCL Supervisor

9. Off-campus Supervisor

10. Off-campus Institution (if applicable)

11. Conditions of Admission

12. Other information, e.g. please stipulate any studentships or scholarships allocated/nominated to be detailed on offer letter

EDUCATION QUALIFICATIONS ALREADY OBTAINED

16a. Detail your education since age 17. Start with the most recent qualifications. Where appropriate include professional qualifications.
NAME OF COLLEGE/UNIVERSITY/ START DATE END DATE QUALIFICATION OVERALL CLASS/ AWARDING BODY (MONTH/YEAR) (MONTH/YEAR) (e.g. BA, BSC) GRADE/GPA STATE COUNTRY IF OUTSIDE THE UK DEGREE TITLE: SUBJECTS STUDIED AND GRADES OBTAINED

EDUCATION QUALIFICATIONS CURRENTLY BEING TAKEN

16b. Detail qualifications yet to be awarded. Where appropriate include professional qualifications.
NAME OF COLLEGE/UNIVERSITY/ START DATE END DATE QUALIFICATION OVERALL CLASS/ AWARDING BODY (MONTH/YEAR) (MONTH/YEAR) (e.g. BA, BSC) GRADE/GPA STATE COUNTRY IF OUTSIDE THE UK DEGREE TITLE: SUBJECTS STUDIED AND GRADES OBTAINED SO FAR

ENGLISH LANGUAGE

17. Is English your first language? ()

YES NO

If NO detail any work experience or education that you have undertaken in English. Provide the date and grade(s) of any English language test taken. Any work experience, education or test must have been within three years of your proposed start date at UCL. A copy of the test certificate should be enclosed with this application.

FOR OFFICE USE. ADMISSIONS ADVICE FOR THE GRADUATE ADVISER/DEPARTMENTAL ADMISSIONS TUTOR

Academically qualified? ()
YES NOT YET NO REQUIRES SENIOR TUTOR APPROVAL NO

English language satisfactory? ()

YES NO

Qualifications required/other comments:

EMPLOYMENT

18. List your employment to date. You may include a copy of your curriculum vitae if this is more convenient. Medical or dental graduates should include full details of all periods of clinical training and clinical attachments.
NAME AND ADDRESS OF EMPLOYER STATE COUNTRY IF OUTSIDE THE UK START DATE END DATE (MONTH/YEAR) (MONTH/YEAR) POSITION HELD AND MAIN DUTIES

19. General Medical Council (GMC)/General Dental Council (GDC) registration: if you hold either GMC or GDC registration, please provide your reference number.

SUPPLEMENTARY PERSONAL STATEMENT

20. Describe your academic interests and reasons for applying. Research (MPhil/PhD etc.) applicants should state in which research areas or specific projects being offered by the department they are interested. LLM applicants should list the four subjects they wish to study. Applicants for other taught programmes, in particular flexible programmes, should indicate, where appropriate, the options/modules in which they are likely to be interested. Detail your career objectives and any relevant non-academic achievements as well as any publications. Outline any other relevant experience including attendance at specialist workshops or short courses. Continue on a separate sheet if required.

FUNDING

Please refer to the UCL booklet Sources of Funding for Graduate Students or www.ucl.ac.uk/scholarships for information. 21. How will you be financing your studies at UCL? Please () one or more boxes.
PERSONAL/FAMILY RESOURCES LOAN STUDENTSHIP/SCHOLARSHIP SPONSORSHIP OTHER (PLEASE SPECIFY)

22. If you hold or are intending to apply for funding please state: Has it been awarded? ()
NAME OF AWARD VALUE AND DURATION OF AWARD YES DECISION PENDING

Has it been awarded? ()

NAME OF AWARD VALUE AND DURATION OF AWARD YES DECISION PENDING

Please note, completion of this section does not constitute an application for funding.
AVAILABILITY FOR INTERVIEW

23. Where it is feasible, departments interview applicants before recommending admission. Overseas applicants are not normally required to attend but may be interviewed by telephone. Please indicate any periods when you might not be available.
KNOWLEDGE OF UCL

24. Where did you learn about the UCL programme applied for? Please () or write in one or more boxes.
UCL WEBSITE OTHER WEBSITE (PLEASE SPECIFY) PROSPECTUS/DEPARTMENTAL BROCHURE UCL ACADEMIC STAFF

OTHER ACADEMIC STAFF

EMPLOYER

FORMER UCL GRADUATE

STUDENT RECRUITMENT EXHIBITION/FAIR

BRITISH COUNCIL

CAREERS CENTRE

NEWSPAPER/RECRUITMENT GUIDE/MAGAZINE ADVERTISEMENT (PLEASE SPECIFY)

OTHER (PLEASE SPECIFY)

DISABILITY/SPECIAL NEEDS

25. Do you have a disability? ()

YES NO

Please also complete the disability and ethnic origin monitoring form enclosed. Any information on disability will be passed (in confidence) to UCLs Disability Co-ordinator. If you have a disability that may require reasonable adjustments to be put in place, you must independently contact the Disability Co-ordinator to discuss your needs.

REFEREES

26. State the details of the two people who have provided references in the Letter of Reference envelopes that you are returning with this application. Name Position Address Name Position Address

Tel Fax E-mail

EQUAL OPPORTUNITIES POLICY

Tel Fax E-mail

At UCL our principal concern when considering applications is to recruit and select students who are likely to complete the programme successfully and derive benefit from it. Once these requirements are met, we regard other issues such as disability, ethnic origin, sex, marital status, number of children, beliefs relating to religion, politics and sexual orientation as irrelevant.
APPLICANTS DECLARATION

To the best of my knowledge, the information on this application is accurate and complete. (Please note that UCL reserves the right to refuse admission or to terminate a students attendance should it be discovered that he/she has made a false statement or has omitted significant information. If you are offered a place, you will be required to provide evidence of your qualifications.) Data Protection Act 1998: I agree to UCL processing personal data contained on this form, or other data which UCL may obtain from me or other people or organisations while I am applying for admission. I agree to the processing and disclosure of such data for any purpose connected with my studies, or my health and safety while on UCLs premises or for any other legitimate purpose, including the compilation of statutory statistical and personal returns that UCL is obliged to make to government or other agencies. Signature Date

Please return this form, together with two letters of reference, transcripts/diploma supplements (please refer to guidance notes), the disability and ethnic origin monitoring form and, where appropriate, an English language test certificate to:
ADMISSIONS, UNIVERSITY COLLEGE LONDON, THE REGISTRY, GOWER STREET, LONDON WC1E 6BT

UCL REFERENCE FORM FOR GRADUATE STUDY

APPLICANTS NAME: PROGRAMME OF STUDY:

The above student is applying to UCL for admission to a graduate programme of study. To assist us in the selection process, we should be most grateful if you could complete the four sections of this form. 1. (a) How long have you known the applicant? (b) In what capacity do you know the applicant?

(c) If you are an academic referee, please indicate the cohort against whom you are measuring the applicant (e.g. number of students/all students in current year/all students you have ever taught):

2. Please assess the applicant on a scale of 10 (highest) to 1 (lowest) in relation to the following criteria by circling the appropriate number: Intellectual ability 10
PLEASE DETACH REFERENCE FORM BEFORE SENDING

9 9

8 8

7 7

6 6

5 5

4 4

3 3

2 2

1 1

Unable to Comment Unable to Comment

Motivation Written communication skills Verbal communication skills Ability to organise workload Originality Overall assessment of applicant

10

10

Unable to Comment

10

Unable to Comment

10

Unable to Comment

10

Unable to Comment

10

Unable to Comment

3. We would be grateful if you would comment in writing on the applicant including if they have not yet graduated, what final degree classification or grade he/she is expected to obtain and any further relevant information, for example performance in the workplace or suitability for the programme applied for. (Continue overleaf or include a separate signed letter on headed paper if preferred.)

4. Recommendation () I strongly recommend this applicant for the above programme of study. I do not recommend this applicant for the above programme of study.
CONTACT DETAILS

I recommend this applicant for the above programme of study. I am unable to comment.

Name Tel

Signature E-mail

Position Date

Thank you for your co-operation in completing this form. Please enclose this form and each letter in the envelope provided and sign across the seal before returning it to the applicant. Under the terms of the 1998 Data Protection Act, an applicant has the right to access any reference submitted to UCL. Please tick this box if you do not wish the applicant to have access to this reference.
ADMISSIONS, UNIVERSITY COLLEGE LONDON, THE REGISTRY, GOWER STREET, LONDON WC1E 6BT

UCL REFERENCE FORM FOR GRADUATE STUDY

APPLICANTS NAME: PROGRAMME OF STUDY:

The above student is applying to UCL for admission to a graduate programme of study. To assist us in the selection process, we should be most grateful if you could complete the four sections of this form. 1. (a) How long have you known the applicant? (b) In what capacity do you know the applicant?

(c) If you are an academic referee, please indicate the cohort against whom you are measuring the applicant (e.g. number of students/all students in current year/all students you have ever taught):

2. Please assess the applicant on a scale of 10 (highest) to 1 (lowest) in relation to the following criteria by circling the appropriate number: Intellectual ability 10
PLEASE DETACH REFERENCE FORM BEFORE SENDING

9 9

8 8

7 7

6 6

5 5

4 4

3 3

2 2

1 1

Unable to Comment Unable to Comment

Motivation Written communication skills Verbal communication skills Ability to organise workload Originality Overall assessment of applicant

10

10

Unable to Comment

10

Unable to Comment

10

Unable to Comment

10

Unable to Comment

10

Unable to Comment

3. We would be grateful if you would comment in writing on the applicant including if they have not yet graduated, what final degree classification or grade he/she is expected to obtain and any further relevant information, for example performance in the workplace or suitability for the programme applied for. (Continue overleaf or include a separate signed letter on headed paper if preferred.)

4. Recommendation () I strongly recommend this applicant for the above programme of study. I do not recommend this applicant for the above programme of study.
CONTACT DETAILS

I recommend this applicant for the above programme of study. I am unable to comment.

Name Tel

Signature E-mail

Position Date

Thank you for your co-operation in completing this form. Please enclose this form and each letter in the envelope provided and sign across the seal before returning it to the applicant. Under the terms of the 1998 Data Protection Act, an applicant has the right to access any reference submitted to UCL. Please tick this box if you do not wish the applicant to have access to this reference.
ADMISSIONS, UNIVERSITY COLLEGE LONDON, THE REGISTRY, GOWER STREET, LONDON WC1E 6BT

UCL DISABILITY AND ETHNIC ORIGIN MONITORING FORM

Please note that this form will not be passed to any admissions tutor. UCL is required to supply this personal information to the Higher Education Statistics Agency. If you have a disability that may require adjustments to be put in place, you must contact UCLs Disability Co-ordinator, telephone (voice or minicom): +44 (0)20 7679 0100; fax: +44 (0)20 7916 8530; e-mail: [email protected]; address: The Registry, University College London, Gower Street, London WC1E 6BT.
SURNAME FIRST NAMES

DISABILITY Please () one box

00 01
PLEASE DETACH MONITORING FORM BEFORE SENDING

No disability Specific learning disability, e.g. Dyslexia Blind/partially sighted Deaf/hearing impairment Wheelchair user/mobility difficulty Personal care support

06 07 08 09 10

Mental health disability Unseen disability, e.g. diabetes Multiple disabilities Other disability Autistic Spectrum Disorder

02 03 04 05

Are you currently or have you previously been in receipt of a UK disabled students allowance? Please () one box Yes
ETHNICITY Please () one box

No

11 12 13 14 19 21 22 29 31 32

White British White Irish White Scottish Irish Traveller Other White background Black or Black British Caribbean Black or Black British African Other Black background Asian or Asian British Indian Asian or Asian British Pakistani

33 34 39 41 42 43 49 80 98

Asian or Asian British Bangladeshi Chinese Other Asian background Mixed White and Black Caribbean Mixed White and Black African Mixed White and Asian Other Mixed background Other Ethnic background Information refused

Please return this form with the rest of your application to:
ADMISSIONS, UNIVERSITY COLLEGE LONDON, THE REGISTRY, GOWER STREET, LONDON WC1E 6BT