Application Form s13

Application Form

1. Personal details (AS SHOWN ON YOUR PASSPORT) Applications must be typed

Family Name

First Name

Identity Card No (or Passport Number)

Title Choose one Previous Family Name

Date of Birth Male Female (dd/mm/yyyy)

Correspondence address Home address (if different)

Post Code Post Code

Country Country

Tel No Tel No

Mobile Mobile

Email Email

Please include two passport-size photos with your application. Digital photos are also accepted.

2. Course(s) applied for

School of Accounting, Business & Finance Choose one Full Time (day)

School of ICT & Computing Choose one Full Time (evening)

School of Education Choose one Start Date: Month Year School of Health & Social Care Choose one

For Official Use Only

Approved: Yes No Conditions

Fee € Payment Terms

Date Signed *The full Degree consists of 3 consecutive years of study. Course fee is only guaranteed if the entire Degree programme is finalised within the span of 4 years. www.domainacademy.edu.mt v05032015a Initials Page 1 of 8 3. Finance and fee status

All students offering registration might be asked by Domain Academy to supply evidence of financial status to ensure that they complete the course without financial hardship.

Who will be paying fees: Self

Employer

Nationality Country of birth

Country of permanent residence Entry date to Malta (dd/mm/yyyy)

4. Declaration of Criminal Record

To help Domain Academy reduce the risk of harm or injury to their students caused by the criminal behaviour of other students, they must know about any relevant criminal convictions (even if still pending) that an applicant has.

You must answer “Yes” if any of the following statements apply to you.

a) I have a relevant criminal conviction that is still not spent. b) I am currently undergoing criminal proceedings by the competent authorities.

Please indicate if you have a relevant criminal conviction by ticking in the box Yes

For applicants who answer “Yes”, Domain Academy shall ask for more information before making a decision.

5. Have you ever studied previously in Malta?

Yes No At which School/College/University/Institution

If you have been a student at Domain Academy or any of Domain Group’s associate educational institutions, please give the course details below.

Course details Year of completion

www.domainacademy.edu.mt v05032015a Initials Page 1 of 8 6. Previous and present education *PT = part time, FT = full time, DL = distance learning, OT - other

Please list details of all institutions attended since age 11.

Name and address of institution From To Study mode (year) (year) *PT/FT/DL/OT

7. Academic qualifications – examinations achieved

Please list all qualifications taken, whatever the result, in chronological order. Documentary evidence of known results should be sent with this form.

Exam Year Awarding body Subject Qualification Result

8. Academic qualifications – examinations pending

Complete this section only if you are awaiting the result of any examination taken recently.

Exam year Awarding body Subject Qualification

www.domainacademy.edu.mt v05032015a Initials Page 1 of 8 9. English Language (for overseas applicants and applicants who wish to purse studies at degree level)

Entry is conditional on the attainment of the required proficiency in the English Language.

Were any of the previous qualifications taught in English? Yes No

If yes, which

Please give full details, including dates, of any English tests taken/to be taken:

Level Where studied Awarding body Year taken Result

10. Work Experience *PT = part time, FT = full time

Please give details of work experience, training and employment.

Year from Year to *FT/PT Post held Organisation Duties

www.domainacademy.edu.mt v05032015a Initials Page 1 of 8 11. Further information

Please provide any information you feel would support your application.

12. Disabilities / special needs

Please tick the appropriate box(es) and in the space at the bottom of this section indicate any additional support or facilities that you may need from Domain Academy.

0 No known disability 1 Specific Learning Difficulty (eg Dyslexia) 2 Blind/partially sighted 3 Deaf/have a hearing impairment 4 Wheelchair user/mobility difficulties 5 Autistic Spectrum Disorder or Asperger Syndrome 6 Mental health difficulty 7 Unseen disability eg diabetes, epilepsy, asthma or a heart conditions 8 Two or more of the above disabilities/special needs 9 A disability not listed above

I am registered as a Disabled Student with the competent authorities Yes No

If yes, where?

Please details below any additional support or facilities you may need.

Additional support given by Domain Academy may incur extra charges. www.domainacademy.edu.mt v05032015a Initials Page 1 of 8 13. Market research

Please tick the appropriate box to tell us how you first heard about our Diploma programmes.

Advertisement. If so, where?

Article in press, magazine, etc. If so, where?

Website

Web search. If so, which search engine?

Social media. If so, which one?

Personal Recommendation. If so, from who?

Progression from another Domain Academy (or its associates) course. If so, which one?

Other. If so, please specify

Please use the following space to give us any other comments and suggestion you might have about the information we provide for our courses and the way we convey such information.

Declaration

I confirm that the information given on this form is true, complete and accurate and no information requested or other material information has been omitted. I also declare that I confirm and accept all terms and conditions stipulated in this application form including attachments.

Signed: Date: 05/03/2015

Post your application to:

Domain Academy Domain Building, 102/104 Constitution Street, Mosta MST 9055, Malta

You can also present the application form by hand or fax it to +356 21 438 729 or send it by email to [email protected].

www.domainacademy.edu.mt v05032015a Initials Page 1 of 8 Equal opportunities monitoring form

In completing this form you are helping Domain Academy to monitor the fairness of its admissions processes and to ensure equal treatment for all applicants. This form will be separated from your application and will be kept with strict confidentiality by the Quality Assurance Manager. The information supplied might be recorded on our computer system during the application process and in such case, the form will be destroyed as confidential waste. Please tick the box/boxes that best describe you.

I am Female Male

My age today is under 18 18 – 21 22 – 24

25 - 29 30 - 39 40 or over

Please indicate your ethnicity by choosing one of (A) to (F) below and ticking the appropriate box.

A White D Mixed European White and Black Caribbean Outside Europe White and Black African Other White and Asian Other

B Black E Chinese or other ethnic group Caribbean Chinese African Other Other

C Asian F Information Refused Indian Information refused Pakistani Bangladeshi Other

I indicated on my application that I have a disability. Yes No

www.domainacademy.edu.mt v05032015a Initials Page 1 of 8 Student’s Agreement (Terms and Conditions)

Before enrolling for your course, you are kindly asked to read and agree with the following terms and conditions very carefully (by signing this Student’s Agreement you confirm acceptance of all Terms & Conditions):

1. Students are not allowed to install screen-savers, change any computer set-ups or passwords. 2. Authorisation must be sought before students can use any external storage devices (such as USB pens). 3. Mobile phones should be switched off in class. 4. No music devices, computer games or any other similar electronic equipment should be used on Domain Academy premises unless with the prior consent of Domain Academy staff. 5. Smoking is strictly prohibited in the entire Domain Academy campus. 6. Eating/drinking in class is not allowed. 7. The subject of Politics, and any discriminatory comments or remarks regarding political belief, race, ethnicity, origin, gender, age, sexual orientation, language, disability and religion or belief are not allowed within Domain Academy campus. Students are to handle all computer equipment with care. 8. I adhere to all terms and conditions, policies and procedures both current and those which may be introduced from time to time. 9. Full payment is due even in case of termination by the student or suspension by Domain Academy at any point during the course for any reasons whatsoever. 10. Should the course be cancelled by Domain Academy, the student is entitled to the full refund of fees paid. 11. Should the student cancel his/her participation on the course within 8 weeks from the scheduled date of the starting course, the student shall not be entitled to any refund of the fees paid. Students who cancel their participation on the course prior to 8 weeks from the starting date of the course, are entitled to a refund of the fees paid less Euro100 administration fee. In case of a student requiring/ applying for a study visa, no refunds are given once the required visa is issued.

Please be advised that students who do not adhere to the above regulations are subject to expulsion from the course, with no refund.

We thank you for taking the time to read the above and for your co-operation in upholding our standards. Should you wish to clarify any points, please do not hesitate to contact one of our administration staff.

Domain Academy (or associate educational institutes within Domain Group) is associated with a number of players in the industry who may; from time to time be looking to employ the skills you acquire through courses offered at Domain Academy (or associate educational institutes within Domain Group). As part of our student development programme we may wish to recommend your skills to prospective employers in the industry. Tick this box if you do not wish your details to be forwarded to potential employers. 

Domain Academy will hold your personal data on their computer database. This information may be accessed, reviewed and used by the designated staff at Domain Academy (or associate educational institutes within Domain Group) for administrative and marketing purposes. Domain Academy , or its approved suppliers, may also send you details of products and services you may be interested in. If you do not wish to receive such information, please tick the box. 

The personal information provided in this form will only be processed for the purpose of course administration and shall be processed in accordance with the provision of the Data Protection Act, Cap 440 of the Laws of Malta. Certain information may be forwarded by Domain Academy . to the government Ministries or entities to allow the said Ministries and/or entities to measure the take up of any scheme launched by the same Ministry or for other research or statistical purposes.

Course schedules, content and any other items related to the course may be subject to change due to various circumstances which might arise throughout the duration of the course and are beyond the control of Domain Academy. Whilst Domain Academy would ensure that such changes are communicated to students once they are officially available, Domain Academy cannot be held liable for such changes.

If the student applies for any scheme or loan for part or full financing of his/her studies at Domain Academy, the full responsibility for such schemes or loans lies with the student and Domain Academy cannot be held liable for any changes / terminations / suspension of such schemes or loans. Furthermore, Domain Academy cannot be held accountable if the organization awarding the financing scheme or loan fails to honour its commitments towards the student. In any case, the full course fees should be honoured in full by the student to Domain Academy.

Domain Academy may take photos from time to time which can be used for marketing and/or promotional purposes including print and social medai. If you do not wish to feature on such material please tick the box .

You have the right to access, rectify and where applicable, the right to erase data concerning you.

I do hereby authorise Domain Academy to process the data contained in this form for the above-stated purposes.

I have read and agree with all the Terms and Conditions outlined above. Full Name: Identity Card Number or Passport Number:

Signature: www.domainacademy.edu.mt v05032015a Initials Page 1 of 8 www.domainacademy.edu.mt v05032015a Initials Page 1 of 8