Application Form
To be used to apply for postgraduate and part-time
courses only, full-time undergraduate applications
must be made through UCAS at
Please ensure all sections are fully completed.
1 Personal details
Title: Surname/family name (BLOCK CAPITALS):
First name(s):
Previous surname (if changed):
Gender: M/F Date of birth:
Correspondence address:
Contact telephone no.: Mobile telephone no.:
Home address (if different):
Home telephone no.:
Do you have any convictions, cautions, reprimands or final warnings that are not ‘protected’/spent as defined by the
Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013)? YES c NO c
3 Fee status and additional supporting information
2 Details of course you wish to attend
Course title Start date
Mode of study
(please specify)
(ie Year 1, Year 2)
Country of birth: Nationality (citizenship):
Country of permanent residence:
Applicants not born in the European Union please state
Date of first entry to the EU: Date of most recent entry to the EU:
Date from which you have been granted permanent residence in the EU:
Payment of fees
Who is expected to pay your fees? (Research Council, Local Education Authority, yourself, family member, employer, other):
Please attach a copy of your current passport and, where applicable, any Home Office documentation/visa.
Ethnic origin (please tick one):
White c Black Caribbean c Black African c Black other c Asian Indian c Asian Pakistani c
Asian Bangladeshi c Asian Chinese c Asian other c Mixed c Other c Prefer not to say c
Have you previously studied at the University of Bedfordshire (or Luton/DMU Bedford)? YES/NO
If yes, please provide details of the course (title):
Former student reference number:
5 Last two educational establishments attended
Give names and addresses of the last two educational establishments that you attended.
Establishment Full or part-time From (mm/yy) To (mm/yy)
6 Examinations
Please list results, including those pending, and attach photocopies of your certificates or transcripts.
eg GCSE/Degree
Subject Date (mm/yyyy) Institution Result
4 Work experience
Give details of work experience, training and employment. Continue on a separate sheet if necessary.
Job title Name of Organisation Full or part-time From (mm/yy) To (mm/yy)
7 Additional needs
Please indicate if you have a disibility:
No disability c Autistic Spectrum c Visual Impairment c Hearing Impairment c Long-term Health c
Mental Health c Dyslexia c Wheelchair User c Other disability not listed c Multiple disabilities c
Please give further details of any support needs which might necessitate special arrangements or facilities:
Please use this section to tell us about yourself and your reasons for wanting to study this course.
You may prefer to attach a separate statement.
8 Names of referees
Please give the names and contact details of two people who can comment on your suitability for this course, which could include a
teacher, an academic tutor, current employer or work-experience co-ordinator.
You will need to supply references from both the referees given above with your application, which should be on their organisations
headed paper and dated within the last month, or emailed directly from your referee to:
Name Name
Organisation Organisation
Telephone Telephone
Fax Fax
Email Email
Relationship to you Relationship to you
9 Further information
10 Data processing
The information you provide on the application form and any supporting evidence will be used by the University for the following purposes,
determine your eligibility for entry to the University of Bedfordshire
provide you with relevant information to assist you in joining the University (including information about open days, scholarships/
discounts and fees, enrolment at the University, your course, your faculty and the University’s facilities, the local area,
accommodation providers engaged through the University’s approved accommodation system, internships and career opportunities,
visa advice and travel advice)
enable the University of Bedfordshire to compile statistical reports
enable the University of Bedfordshire to initiate your student record
Information that you provide during the application process may be shared with:
relevant government departments and NHS bodies, including: Higher Education Statistical Agency, UK Visas and Immigration, Higher
Education Access Tracker (HEAT), Office for Fair Access and the Office for Students, Student Loan Company, Department for Education
and its agencies , Frontline (a Government funded body which commissions social work training), ESFA (for apprenticeships)
public sector regulatory bodies such as OFSTED and the Office for Standards in Education
NARIC (for the assessment of international qualifications)
UCAS (for undergraduate full-time provision)
bodies responsible for the professional accreditation of your course, if applicable
the Police or other authority in relation to crime prevention or investigation, or in association with the Government’s Prevent agenda
accommodation providers (where applicable) who are engaged through the University’s approved accommodation system: Liberty
Living and Student Village
John Smiths bookshop and Aspire Gym so that if you are eligible to receive a BedsMoney card, you can use it to purchase learning
materials or gym membership, respectively
The University of Bedfordshire will take all reasonable steps to provide the educational service set out in its prospectuses. Should
industrial action or other circumstances beyond the control of the University of Bedfordshire interfere with its ability to provide such a
service, the University of Bedfordshire will take reasonable steps to minimise the resultant disruption. The University of Bedfordshire does
not undertake any absolute obligation whatsoever to provide an educational service in the manner specified in its prospectuses or in any
other document, nor does it undertake any other obligation in respect of the provision of an educational service which is more onerous
than the obligations set out therein.
Should you become a student of the University of Bedfordshire, the notice shall be a term of any contract between yourself and the
University. Any offer of a place made to you by the University of Bedfordshire is made on the basis that in accepting such an offer you
signify your consent to the incorporation of this notice as a term of any such contract.
Notes for guidance
Before completing the form, please ensure that you read these
notes carefully. You should also read the current University of
Bedfordshire literature relating to the course(s) in which you are
interested. The University’s regulations are to be found at at
Students with Experience
The University of Bedfordshire welcomes applications from
students with experience, including those who do not have
conventional qualifications for admission to higher education in the
UK. Full account is taken of relevant experience and other
educational achievements.
Section 1 Personal details
Complete this section in BLOCK CAPITALS.
Section 3 Fee status
Please state your country of permanent residence and give details
of who you expect to pay your fees for the proposed course.
Section 6 Qualifications
Enter the exact subject name used by the examining body and
the name of the examining body in full. If you have qualifications
obtained outside the UK, you should give details of all examinations
taken as preparation for entry to higher education (eg School and
Higher School Certificate, Apolytirion, Baccalaureat). Applicants
with qualifications obtained in a language other than English must
attach a certified English transcript to the form.
Section 7 Additional needs
Describe your condition and, where it is not obvious, indicate
whether you have special needs.
11 Declaration and submission
I hereby certify that all of the above information is correct and complete, and that I wish to apply for admission as a student of the
University. I also declare that, if admitted, I shall conform to all the Rules and Regulations of the University of Bedfordshire. I understand
that the submission of any misleading information during the admission process could lead to the immediate cancellation of my application
and the withdrawal of any offer made. In the event that I register as a student of the University of Bedfordshire, I hereby undertake to pay,
as and when due, all University fees.
I grant permission to the University of Bedfordshire to verify my qualifications with the relevant exam board and/or institution and/or
NARIC, if necessary. I grant permission to the University of Bedfordshire to request information pertaining to my current or previous visa
status in the UK from the Home Office, if necessary. I grant permission for the University to contact any referees nominated by me during
the application process to request or verify a reference.
Signature: Date:
any partner of the University which is delivering the programme or whose premises are used for the delivery of a programme for
which you have applied
your employer, if you are applying for an apprenticeship, in accordance with the contract between your employer and the University of
In the event that you do not register as a student of the University of Bedfordshire, the University will retain your personal information for
the rest of the academic year for which you have applied plus one further academic year in accordance with the University’s data retention
policy. In the event that you do register, your data will be managed as per the Student Privacy Policy which you will sign at registration.
Please return the completed form to:
University of Bedfordshire
UniversIty Square
Luton, Bedfordshire
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