Part-time Application

 

Please complete this form so that your application may be started. If you do not receive a message when you press submit, please check carefully that you have supplied all the information asked for.

 

A. Course Details

 

Name of Course or Modules:

 

Year/level of course or modules:

 

Student I.D:

 

Course number:

 

B. Personal details

 

Title, (Mr/Mrs/Ms/Miss/Dr):

 

Surname:

 

Forenames:

 

Home address:

 

address line 2

 

Town/City

 

Postcode:

 

Tel. no:

 

Date of Birth. (please enter dd/mm/yyyy numbers only)

 

day

 

Month:

 

Year

 

Nationality:

 

Country of permanent residence*:

 

Have you previously studied at the University select yes no

 

If yes, please state previous course, and year of study:

 

C. Education

 

Name of last School/College attended:

 

Address of last School/College attended:

 

Academic/Professional Qualifications

 

Awarding Body

 

Examination dates month

 

Examination date year

 

Programme or Examination Title

 

Level

 

Result grade

 

D. Work experience

 

Please give details of your three most recent periods of employment

 

Employment 0ne:

 

Job Title

 

Name of Company or organisation

 

FT/PT

 

From (mm/yyyy)

 

To (mm/yyyy)

 

Employment two:

 

Job title

 

Name of company or organisation:

 

FT/PT

 

From (mm/yyyy)

 

To (mm/yyyy):

 

Employment three:

 

Job title:

 

Name of company or organisation:

 

FT/PT

 

From (mm/yyyy):

 

To (mm/yyyy):

 

E Payment details:

 

I am unwaged select yes no

 

I am paying my own fees select yes no

 

My employer/sponsor is paying my fees select yes no

 

Name of employer/sponsor:

 

Address:

 

Town/city:

 

Postcode:

 

Telephone:

 

Please note that if your sponsor fails to pay you will be personally responsible for payment.

 

F Supporting Information

 

If you have extra information please email it to enquiry@smu.ac.uk

 

G Special needs

 

Do you have Special needs? select yes no

 

If yes, further details to be submitted in writing.

 

H Declaration

 

Do you have any criminal convictions, excluding motor offences? select yes no

 

If yes, further details to be submitted in writing.

 

If you do not receive a message when you press submit, please check carefully that you have supplied all the information asked for.

 

 

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