The University of Birmingham

Collaborative Postgraduate Research Enrolment Form Registry, Academic Services

PART 1: Personal details

Surname (Family Name)

Forename(s) Title (e.g. Mr, Ms, Mrs, Dr) Date of birth

Gender Male Female Other

Have you previously studied at If yes, please enter your student ID number the University of Birmingham? Yes No

You must include a copy of your passport/national identity card with this application. Any applications submitted without these documents will be returned.

Copy of passport attached

Home address Term time address (if different from home address)

Phone number Email address

PART 2: Programme details

Home university UoB Programme title Date of entry into this programme

Module code(s) and title(s) (if known)

October 2016 1 PART 3: Nationality and residence

Nationality Country of birth Country of permanent residence

If you are a non-EU national, do you require a visa to study in the UK? Yes No

If you require a visa to study in the UK, you must include a copy of your visa with this application. Any applications submitted without these documents will be returned.

Copy of visa attached

PART 4: Disability

Please select the description(s) you believe best applies to you

00 No know disability 01 Learning diff, e.g dyslexia 02 Blind/visual impairment 03 Deaf/hearing impairment 04 Wheelchair user/mobility diff 05 Personal care support 06 Mental health difficulties 07 Long standing illness ,e.g. HIV 08 Multiple disabilities 09 Disability not listed 10 Autistic spectrum disorder 11 I’d rather not say

October 2016 2 PART 5: Declaration of Registration

Please not that you cannot become a registered student of the University until you have read and signed to say that you agree to the declaration. The declaration statement provides links through to the web pages for the University Charter, Statutes, Ordinances, Regulations and Codes of Practice (including the Conditions of use of Computing and Network Facilities) of the University and to the summary changes made for the 2016/17 academic year, so that you can view these in full before agreeing to the declaration

Declaration

I declare that the information that I have given is true and complete and, being admitted to be a student at the University of Birmingham, promise to obey the Charter, Statutes, Ordinances, Regulations and Codes of Practice, to submit to discipline, and to uphold its honour and credit to the best of my ability, both while a student and, if admitted to a degree, as a graduate. I understand that any mis-statement by me of my qualifications or circumstances may lead to the termination of my registration as a student. I agree to the University of Birmingham processing personal data obtained as part of online registration, or other data that the University may obtain from me or other sources, in accordance with the Data Protection Act 1998. I agree to the processing of such data for any purposes connected with my studies, my health and safety or any other legitimate reason and to the publication of my degree classification at the end of my studies (see Student Handbook for detailed information about Data Protection). I understand that my academic data may be disclosed to organisations acting as my sponsor.

Neither the student nor the University shall be liable to each other for any failure or delay in performing obligations, if failure is due to any cause beyond that party’s reasonable control e.g. war, national emergency, terrorism, acts of god, government restrictions, industrial action or unforeseen closure of the University.

In accordance with requirements of S22(3) Education Act 1994 the University and the Guild have issued a Student Code of Practice which is available from Legal Services at [email protected].

Signed: Date:

October 2016 3 PART 6: Right to Study declaration – to be completed by the home institution for international students only

I confirm that the student’s immigration permissions have been checked and he/she has the right to study at this institution

Signed Name

Position Date

Institution

PART 7: To be completed by an authorised person within the UoB School/Department

I agree to the admission of the student to the programme stated above and confirm that there is a collaborative agreement in place to cover this arrangement

Signed Name

Position Date

October 2016 4