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					APPLICATION FOR M.Sc. / Ph.D. BY RESEARCH: CHEMISTRY PRE-REGISTRATION FORM
(Please type or use CAPITAL LETTERS in black ink) Name: Contact telephone: E-mail Address (Print clearly): Please tick the research degree for which you are applying: Current University: Current degree course (with expected class of degree): Date when degree result is expected (e.g. 12th June, 1st July, etc.): Give details of any other degree-level courses already completed: Degree: Degree: Degree: Institution: Institution: Institution: Date: Date: Date: M.Sc. Ph.D. Nationality: Age:

Please only complete this section if you are a non-EU applicant. Do you have a grant to fund your studies and living expenses? (Yes/No) If so, value (£): Have you applied for funding? (Yes/No) Please give details of grant / grant application (with result dates, amounts and funding organisation): Funding Organisation:

Please only complete this section if you are an-EU or UK applicant. Would you require a grant for both fees and living expenses? (Yes/No) Have you applied for funding? (Yes/No) Please give details of grant / grant application (with result dates, amounts and funding organisation):

Is English your native language? (Yes/No) Have you taken an English Language course? (Yes/No) If YES, give the date and which course (TOEFL, IELTS, etc.): If NO, will you be taking a course? (Yes/No) Date result due:

Please give the area(s) of study within chemistry that you are interested in: Biological Chemistry; Materials: Synthesis and Structure; Optical and Molecular Electronics; Soft Matter, Surfaces and Interfaces; Sustainable Chemistry and Catalysis; Theory and Dynamics. See: www.dur.ac.uk/chemistry/research/ (1) (2) (3) (4) Please list Durham staff whose research work interests you (giving an order of preference and order of preferred project, if known). See: www.dur.ac.uk/chemistry/staff/ (1) (2) (3) (4) Dates when available for interview (UK applicants only)*:

Names and addresses (including email) of two academic referees: (2) (1)

* The Chemistry Department will reimburse reasonable travel costs incurred by applicants when attending for interview (UK applicants only). PLEASE NOTE YOU SHOULD ARRANGE FOR YOUR C.V. AND REFERENCES TO BE SENT DIRECTLY TO THE DEPARTMENT – your application cannot be processed without these. Two reference forms are given at the end of this document. I am interested in making an application to read for a higher degree in Durham. Signature: Date:

PLEASE RETURN COMPLETED FORM TO: Miss J. Eccleston (Graduate Admissions Secretary), Department of Chemistry, Durham University, South Road, Durham DH1 3LE, UK. (Fax: 0191 384 4737. Email: jean.eccleston@durham.ac.uk). NOTE: Please return by email where possible.

Chemistry Department Postgraduate Admissions Office CONFIDENTIAL REFERENCE
The candidate should complete section A, and then send a copy to each of the referees named on the application form

SECTION A (to be completed by the candidate)
Full name of candidate: … …………………………………………………… Proposed degree (Ph.D. or M.Sc.):……………………Proposed field of study: ………………………………………………….. Proposed start date: ……………………………….

SECTION B Notes for the guidance of the referee
The person named above has applied to Durham University as a candidate for postgraduate study in Chemistry, and has given your name as a referee. We would be very grateful if you could give us a confidential opinion on the suitability of this candidate for the proposed course of research. The referee’s report is an important and integral part of the selection process, and the information you give will be used to assist departmental staff in making their decision. All information provided will be processed in accordance with the Data Protection Act 1998 and the University’s registration with the Office of the Information Commissioner. To assist the Department and University in evaluating the intellectual and academic potential of the candidate, it would be particularly helpful if referees could cover the following aspects in their reference: a. b. c. d. e. f. g. Length of time and capacity in which you have known the applicant Applicant’s qualifications, level of performance and exam result/s (or expected result/s) Your assessment of the applicant’s potential/suitability to undertake postgraduate study/research Candidate’s motivation and intellectual capacity If the candidate was/is employed by your organization, their duties and standard of work What you consider to be his/her main strengths and weaknesses If the candidate’s first language is not English, whether you consider his/her ability to read, write, speak and comprehend English adequate for the programme applied for. h. Any other information you think relevant and which you feel would assist the University in making its decision PLEASE USE THE SPACE ON THE NEXT PAGE OF THIS FORM FOR YOUR REFERENCE Please return the reference form to the candidate in a sealed envelope, or return it directly to: Miss J. Eccleston (Graduate Admissions Secretary) Department of Chemistry Durham University South Road Durham, DH1 3LE United Kingdom. Telephone: Fax: Email: 0191 334 2100 [from outside the UK +44 (0) 191 334 2100] 0191 384 4737 [from outside the UK +44 (0) 191 384 4737] jean.eccleston@durham.ac.uk

CONFIDENTIAL REFERENCE

Name of referee: ………………………………………………………………………………………………………………………… Post or status: …………………………………………………………………………………………………………………………… Address: …………………………………………………………………………………………………………………………..……… …………………………………………………………………………………………………………………………………… ………... Telephone: ……………………………………………………….Fax:...………………………………………………………….…… Email: …………………………………………………………………………………………………………………………………….. Name of candidate: ……………………………………………………………………………………………………………………... Should the candidate request access, under the Data Protection Act 1998, to the personal data held on them by the University, would you wish this reference to remain confidential? Yes No

PLEASE CONTINUE ON AN ADDITIONAL SHEET IF NECESSARY Signature of referee: …………………………………………………………………Date: …………………………………
Please return to the candidate in a sealed envelope, or return direct to the address shown overleaf. Thank you.

Chemistry Department Postgraduate Admissions Office CONFIDENTIAL REFERENCE
The candidate should complete section A, and then send a copy to each of the referees named on the application form

SECTION A (to be completed by the candidate)
Full name of candidate: … …………………………………………………… Proposed degree (Ph.D. or M.Sc.):……………………Proposed field of study: ………………………………………………….. Proposed start date: ……………………………….

SECTION B Notes for the guidance of the referee
The person named above has applied to Durham University as a candidate for postgraduate study in Chemistry, and has given your name as a referee. We would be very grateful if you could give us a confidential opinion on the suitability of this candidate for the proposed course of research. The referee’s report is an important and integral part of the selection process, and the information you give will be used to assist departmental staff in making their decision. All information provided will be processed in accordance with the Data Protection Act 1998 and the University’s registration with the Office of the Information Commissioner. To assist the Department and University in evaluating the intellectual and academic potential of the candidate, it would be particularly helpful if referees could cover the following aspects in their reference: i. j. k. l. m. n. o. Length of time and capacity in which you have known the applicant Applicant’s qualifications, level of performance and exam result/s (or expected result/s) Your assessment of the applicant’s potential/suitability to undertake postgraduate study/research Candidate’s motivation and intellectual capacity If the candidate was/is employed by your organization, their duties and standard of work What you consider to be his/her main strengths and weaknesses If the candidate’s first language is not English, whether you consider his/her ability to read, write, speak and comprehend English adequate for the programme applied for. p. Any other information you think relevant and which you feel would assist the University in making its decision PLEASE USE THE SPACE ON THE NEXT PAGE OF THIS FORM FOR YOUR REFERENCE Please return the reference form to the candidate in a sealed envelope, or return it directly to: Miss J. Eccleston (Graduate Admissions Secretary) Department of Chemistry Durham University South Road Durham, DH1 3LE United Kingdom. Telephone: Fax: Email: 0191 334 2100 [from outside the UK +44 (0) 191 334 2100] 0191 384 4737 [from outside the UK +44 (0) 191 384 4737] jean.eccleston@durham.ac.uk

CONFIDENTIAL REFERENCE

Name of referee: ………………………………………………………………………………………………………………………… Post or status: …………………………………………………………………………………………………………………………… Address: …………………………………………………………………………………………………………………………..……… …………………………………………………………………………………………………………………………………… ………... Telephone: ……………………………………………………….Fax:...………………………………………………………….…… Email: …………………………………………………………………………………………………………………………………….. Name of candidate: ……………………………………………………………………………………………………………………... Should the candidate request access, under the Data Protection Act 1998, to the personal data held on them by the University, would you wish this reference to remain confidential? Yes No

PLEASE CONTINUE ON AN ADDITIONAL SHEET IF NECESSARY Signature of referee: …………………………………………………………………Date: …………………………………
Please return to the candidate in a sealed envelope, or return direct to the address shown overleaf. Thank you.


				
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