Research Degrees Application Form Please complete this form in BLOCK CAPITALS Course details Subject area

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1 Research Degrees Application Form Please complete this form in BLOCK CAPITALS Course details Subject area Mode of study Full-time Part -time Proposed date of entry - Personal details Will you require a visa to study? Yes No Title Male/Female Surname/Family name_ Previous surname First name(s) Date of birth (dd-mm-yy) - - Permanent home address * (see note) Postcode Telephone no. address Contact address (if different from home address) Postcode Telephone no. address Fees information Who is expected to pay your fees? Yourself Sponsor Research funding body If you have indicated that a sponsor or research funding body is expected to pay your fees, please provide the name and contact details of the sponsor or funder. Name and contact details of sponsor/funding body Further details Country in which you have unrestricted right to reside/live Country of birth Nationality (as stated on your passport) Have you been permanently resident in the UK/EU for the last three years for other than educational purposes? Yes No Please give date of entry Do you have any unspent criminal convictions in any country? Yes No Passport number (non-uk/eu only) Page 1 of 7

2 Learning support needs Do you have a disability, medical condition or learning difficulty? (If your answer is yes Please give brief details; our Student Support Service will contact you and note that we will require documentary evidence of the above in order to make adjustments to the learning environment for you.) Education, qualifications and training Yes No Higher education/further education/secondary education (please list most recent first) Name of institution From (mm/yy) To (mm/yy) Full-time? Qualifications completed or relevant training undertaken (please list most recent first) Qualification Subject Grade Date awarded Qualifications pending or continuing training Qualification Subject Expected grade Date (mm/yy) Page 2 of 7

3 Evidence of English language level For English language level required please visit: If you re not native speaker, please complete one of the two options below Name of last examination taken (eg IELTS or TOEFL)...Result Original/copy of certificate enclosed? Yes No If No please explain OR Evidence of study through the medium of English enclosed? Yes No Professional body membership Professional body Date joined Employment Current employer Name of organisation Address Department Job title Date appointed Previous employers (please list most recent first) Organisation Position held From (mm/yy) To (mm/yy) Page 3 of 7

4 Supporting information Outline research proposal Please indicate in general terms the area of your research interest. Please use the headings below to form the basis of your outline. Approximately one to two sides of A4 are expected. For PhD: Proposed area of research Aim and focus of the study Context for the research Research methodology, including data collection and analysis Research skills Indicative references/publications Approximately one to two sides of A4 are expected. Outline research proposal Please insert your research proposal below. Page 4 of 7

5 Our university reserves the right to submit any application to study for a research degree through TurnitinUK plagiarism detection software. Page 5 of 7

6 Referees Please provide two references on letter headed paper, signed and dated. We require two academic references to support applications for MPhil and PhD. Applicants for Professional Doctorates (DBA, EdD and DProf) and MD (Res) are to provide one academic and one professional reference. Name of referee 1... Organisation... Relationship to you... Reference enclosed Reference to follow Name of referee 2... Organisation... Relationship to you... Reference enclosed Reference to follow Provisional supervisor If you have discussed your application with a particular academic member of staff, please state that person s name here Name Telephone no. address Declarations Do you have any unspent criminal convictions? Yes No A criminal record will not necessarily be a bar to obtaining a place at Anglia Ruskin University. A satisfactory Disclosure and Barring Service check will be required for successful applicants to courses which include placements where students work with children or vulnerable adults. Data Protection Act 1998 I agree to the University processing personal data contained in this form or other data which the University may obtain from other people. I agree to the processing of such data for any purposes connected with my studies or my health and safety whilst on the premises or for any legitimate reason including communication with me following the completion of my studies. In addition, I agree to the University processing personal data described as sensitive data within the meaning of the Data Protection Act 1998, such processing to be undertaken for any purposes as indicated in the declaration above. If my employer/sponsor is supporting my studies by paying my fees/allowing me study time I agree to my employer/sponsor being informed of the progress of my application and of my studies if I am accepted onto the course. Agent referral To be completed if applying with the assistance of an overseas recruitment agent I confirm that I give the following Anglia Ruskin recruitment partner authorisation to discuss my application with staff at Anglia Ruskin University, and receive correspondence from Anglia Ruskin University on my behalf. Company... Contact person ... Telephone no.. Declaration I certify that, to the best of my belief, the information I have provided is complete and true. Signature of applicant... Signature of guardian... if applicant is under 18 years Date Date Page 6 of 7

7 Supporting documentation Please note that all applicants must include copies of the following when returning this application form: Academic certificates (officially translated if not UK) Academic transcripts, including subjects studied and grades achieved (officially translated if not UK) English language certificate (if not UK National) Photocopies of passport to include photograph and personal detail pages. International applicants currently residing in UK must also provide photocopies of visa and immigration stamps. References (as outlined above) This application will only be processed when the required documentation is received Please submit your completed application form with supporting documentation as follows: UK/EU applicants Fax: +44 (0) Post: Admissions Office, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, CM1 1SQ International applicants Fax: +44 (0) Post: International Admissions, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, CM1 1SQ Page 7 of 7

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