FOR UNIVERSITY USE ONLY
SITS Applicant No. SITS AoS Code:
Decision Interview Date:
Reject Conditions of offer:
Offer
Signed: (Admissions Tutor/Course Director)
Equal Opportunities Monitoring
APPLICATION FORM
Please complete in BLOCK CAPITALS
Name: Date of birth:
THIS INFORMATION WILL NOT BE GIVEN TO ADMISSIONS TUTORS INVOLVED IN MAKING DECISIONS ABOUT YOUR ELIGIBILITY FOR THE COURSE.
This form requests a signicant amount of personal information. The information you provide will be used for this purpose and monitoring of equal
opportunities only. It will be treated in condence and will only be seen by those whose jobs require them to do so.
As part of its equal opportunities policy, Birmingham City University monitors applications by gender, ethnic origin and disability. Provision
of information on ethnic origin is voluntary but we hope you will agree to provide it to assist us to monitor our equal opportunities policy.
Please tick the appropriate box.
10
White
15
Gypsy or Traveller
21
Black or Black British - Caribbean
22
Black or Black British - African
29
Other Black background
31
Asian or Asian British - Indian
32
Asian or Asian British - Pakistani
33
Asian or Asian British - Bangladeshi
34
Chinese
39
Other Asian background
41
Mixed - White and Black Caribbean
42
Mixed - White and Black African
43
Mixed - White and Asian
49
Other Mixed background
80
Other Ethnic background
98
Do not wish to provide information
Have you ever been in care? Yes No Don’t want to disclose
Do any of your parents have any higher education qualications
such as a degree, diploma or certicate of higher education? Yes No Don’t know
Please return to:
International Ofce
Level 2 University House
15 Bartholomew Row
Birmingham
B5 5JU
