Standard Application for Department of Professional Development
Area of study (see note 1) Venue of Study
Course Tutor Year & Term of Entry
Family/Surname First Names (In full)
Mr Mrs Miss Ms Other If relevant, known as:
Family/Surname at 16th Birthday (if different) Date of Birth
Home Address (see note2) Term Time Address (see note 3)
Post Code Post Code
Telephone Numbers Personal Email
Mobile (block capitals,please, email addresses are not case sensitive)
Next of Kin/relationship Contact telephone number in case of emergency
DISABILITY Yes No
Do you consider yourself to have a disability?
Do you have any physical or other disabilities or medical conditions (See note 6 & insert code)
which might necessitate specific arrangements or facilities?
Have you made an application for a Disabled Student’s Allowance (DAS)?
Are you intending to make an application for a Disabled Student’s
GENDER ETHNICITY (see note 4) NATIONALITY DOMICILE (See note 5)
We need information from you to determine your fee status. If this section of the form is not
complete the university will presume that for fee-purposes you are an overseas fee-payer.
Section 1 Are you a UK National? Yes No
If you answered Yes in Section 1, please now go to PART 3 (Equivalent Level Qualifications)
Are you an EEA National? Yes No
Are you a Swiss National? Yes No
Are you a Turkish worker
in the UK?
State your main country of residence:
Section 2 In which countries have you been resident for the last three years?
Country Main purpose of your residence
Date of first entry to the EU:
Section 3 Date of most recent entry to
If you are not a UK National, or EEA/Swiss National please state:
Country of birth:
Country of residence:
Section 4 Address:
Do you require a student visa? Yes No Don’t know
Do you require a student visitor visa? Yes No Don’t know
(for students studying 6 months or less)
If you are not a UK/EEA citizen and do not require a student visa, what is your UK immigration
Indefinite Leave to Yes No Yes No
enter/remain Discretionary Leave to remain
Refugee status granted Spouse of student visa holder
Section 5 Dependent of student Work Permit
visa holder Other (please state):
Start and end dates of current leave (UK Immigration Permission) if applicable
Start Date: End Date:
If you are not a UK or EU national you must provide evidence of your status in the UK by enclosing
a copy of your visa/work permit or Home Office letter with this application form.
You will be required to provide originals of these documents at registration.
Equivalent Level Qualifications
Please give details of all academic qualifications specified in this section. Attach additional
information if there is not enough space. In this section you must enter all your qualifications
especially if you have any that are at an equal or higher level to the programme you are applying for.
Name & Address of
Dates Taken Subjects taken Results
A-Levels or equivalent
Degree (or equivalent):
Any other Relevant
Equivalent or Higher Level Qualifications
If you have a qualification that is equivalent to, or higher than the one you propose to take this may
affect the fee you will be charged. If you leave this category blank the expectation is that you have
an equivalent or higher qualification and will be liable for the higher fee.
Please indicate by ticking one of the following options:
I have a qualification equivalent to, or higher than the one I wish to study
I don’t have a qualification equivalent to, or higher than the one I wish to study
I do not know if I have a qualification equivalent to, or higher than the one I wish to study:
Please insert the name of the highest qualification you have so that we can check to see if it is
higher or equivalent to the qualification you are taking:
FEES/Source of Finance
Home/EU Students, please chose from the following options:
Student Loan Company Sponsor
Self Payer NHS/GSCC
Overseas Students, please, chose from the following options:
Self Payer Sponsor
Programme Specific Information Sections
Professional Qualifications (e.g. teacher’s Certificate/PGCE/NPQH)
Place and Dates of Study Qualification Gained Date Awarded
Details of any previous accredited Professional Development Courses undertaken
Only complete this section if you are applying for credit exemption for relevant credits gained up to
the value of 90 credits. (NB. Advanced Certificates may act as entry to M level courses but cannot be
used as credit towards M level Study.)
Please, note that when credits are imported, a formal procedure sets in. This may incur a charge.
Details of Courses you wish to Issuing Body Date & Level of Award
be considered for exemption
Only include courses completed within
the last 5 years, as this is the time limit
for credit transfer
Present Position Include details of employer, job title and responsibilities
Qualified Teacher Status for Teaching in Schools in
England and Wales:
Number of Years Teaching Experience if applicable:
Criminal record bureau (CRB) Have you been checked? Yes No
Source of Finance
Please state the name and address details of person or body to be
invoiced for your fees
DFES/QTS Number if applicable HESA Number if applicable
Please indicate below where you first found out about this course:
REFEREES Please, give details of two referees who can be approached for their opinions on your
suitability for the course.
Referee 1 Referee 2
DATA PROTECTION ACT 1998:
The information that you have supplied will be processed and held on computer. The data
may be processed for the purpose of compiling statistics, and passed to the Higher
Education Statistical Agency. By signing and returning this application form you will be
deemed to be giving your consent to the processing of data contained on it.
I consent to the processing of the data contained in my computer record. I hereby grant Canterbury
Christ Church University authority to release information relating to my academic status to my
funding body (if applicable).
If sending electronically please type your name
Note: Please ensure that all information is complete – it is required for records and statutory
returns. Failure to complete all sections may delay the processing of your application and
Where to send your application:
If sending electronically, please email it to: firstname.lastname@example.org
Or post it (marked ‘Application’) to:
Department of Professional Development
Faculty of Education
Canterbury Christ Church University
Kent, CT2 9AG
Do not forget to sign the form and enclose copies of qualifications.
If accepted you will be required to bring originals of ID and to upload a digital photograph
to activate your university account enabling you to access student facilities.
For Office Use Only
Acknowledgment sent Date Offer Made Date
Yes No Yes No
Programme Director Signature:
NOTES ON THE COMPLETION OF THE APPLICATION FORM
The Application Form will be the basis of our computer record and records held by your College,
Department/Faculty and Tutor. Please complete it carefully either electronically or, if completing by
hand, using BLOCK CAPITALS in black ink or biro. All items should be completed if possible.
Evidence of previous qualifications being used for entry onto a programme before the start of the
course must be attached to the application form. Original copy of ID will required at registration.
Acceptable forms of ID are: Valid Passport, Birth Certificate, Marriage Certificate (along with birth
certificate) or EU Identity Card. Driving Licence or any other form of ID will NOT be accepted
Note 1 AREA OF STUDY : programme/course details (<< Back to the form)
Note 2 Enter you full home address, including postcode. (<< Back to the form)
Please indicate any gap in the postcode by a blank space.
Note 3 Enter your full employment address, including postcode. (<< Back to the form)
Note 4 ETHNICITY (<< Back to the form)
11 White – British 12 White – Irish 19 Other White Background
21 Black Caribbean 22 Black African 29 Black Other
31 Indian 32 Pakistani 33 Bangladesh
34 Chinese 39 Asian Other 41 White & Black Caribbean
42 White & Black African 43 White & Asian 49 Other mixed background
80 Other 98 Information Refused
Note 5 DOMICILE – your main country of residence (<< Back to the form)
Note 6 DISABILITY (<< Back to the form)
00 No disability 03 Deaf/Hearing impediment 06 Mental health difficulties
01 Dyslexia 04 Wheelchair user/Mobility 07 Unseen disability (e.g.
difficulties Asthma, Diabetes, Epilepsy,)
02 Blind/Partially sighted 05 Personal Care Support 08 Multiple disabilities
09 Other disabilities not specified