Student Referral Form
CONSENT FOR THE USE OF APPLICANT PERSONAL DATA BY CU*
Under the terms of the Data Protection Act 1998 (“Act”), the General Data Protection Regulation ((EU) 2016/679) (‘’GDPR’’) and any superseding Data
Protection Legislation, CU requires your consent to use any personal data for the purpose of the student referral scheme.
1. What data do we collect?
We would like to collect the following personal data:
Your name, email, phone number, programme and if applicable chosen start date of your course at CU London.
2. Why do we need to collect this data?
It will be used for;
• Contacting via telephone the referred candidate to establish whether they want to join CU London.
• Processing this application form
• Sending you email alerts relating to this application form
3. How long we will retain your data?
We will store your data on a secured university drive for a period of 26 weeks, for CU London internal use.
4. Your Consent
Without your express permission we cannot process your application form, meaning we will be unable to assess or respond to your application form.
CU London is trading name of Coventry University College Limited, a company wholly owned by Coventry University.
How to fill in the Student Referral Form in three easy steps.
Step one Step two Step three
Referrer
Complete the requested items
on page two/section one on
page three.
Referred
Complete section two on page
two. This must be filled out/
signed by the person being
referred.
Both
Both the Referrer and the
Referred sign at the bottom of
page seven. The Referrer should
then return the completed form
to Registry at CU London
or email it to registry.cul@
coventry.ac.uk.
1
Under the terms of the Data Protection Act 1998 (“Act”), the General Data Protection Regulation ((EU) 2016/679) (‘’GDPR’) and any
superseding legislation, I consent to CU London processing and/or sharing my data for the purpose set out above.
I understand and agree that:
a) CU London will store copies of my data on their manual and electronic systems.
b) CU London will not transfer my personal data sets to a destination outside the EU.
c) CU London will disclose my personal data securely within Coventry University Group only.
d) CU London will not disclose my data to any other 3rd party organisations not specified here
without your consent and unless required by law within and outside of the EU.
e) CU London will dispose my data securely in accordance with the Act, after the retention
period specified above.
Your data will be used for the following purposes. Please indicate your consent accordingly:
I agree to my data being used for processing this application/form -
I agree to my data being used to send me email alerts relating to this application/form -
I agree to my data being used for analysing, within CU London, outcomes specifically in relation to this scheme -
I
also understand that I can withdraw my consent at any time by contacting registry.cul@coventry.ac.uk.
Name of Applicant:
Signature of Applicant:
Date:
In the alternative if you are unable to provide your physical signature above then you may tick the box below on the basis that
you accept by ticking the box you are providing your consent to CU London to use your personal data for the purpose above in
accordance with the General Data Protection Regulation ((EU) 2016/679) (‘’GDPR’).
Name (please print)____________________________ Date________________________
For CU London Use
Member of staff responsible for obtaining information and consent for use of student personal data:
Office Details:
Signed: …………………………………………… Date: ………………………………………..
Step one
Referrer
2
No
No
No
Section 1: Referrer
If you are a current applicant, student, alumni or a member of the public,
please fill in the following:
Name:
Programme enrolled
(if applicable)
Student ID
(if applicable)
Email address Contact No
Section 2: Details of the person referred
Name of the referred student:
Programme applying for Start Date
I hereby declare that the above information is true. I have also read the attached terms
& conditions and criteria & rules associated with the scheme.
Referrer’s signature:
Referred student signature:
Date:
Section 3: Internal Use Only – Verification of Claim
Current Student Alumni Applicant Member of the Public
Copy of application form
Copy of receipt of 1st instalment of tuition fees payment
Copy of receipt of all non-tuition fees (as applicable)
Verification Done by
Name: Designation:
Remarks, if any:
Signature: Date:
Step oneStep two
ReferrerReferred
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Section 4: Approval by Management
Name: Designation:
Remarks, if any:
Signature: Date:
Criteria & Rules:
1. Applicants to the referral scheme cannot refer themselves.
2. You must use the official version of the referral form. Max of one referral per form.
3. Forms must be legible and have all information competed.
4. The referred student must enrol with CU London within 2 intakes of the referral form being received
by admissions at CU London.
5. Referral forms will not be processed if an earlier application to study has been received from the student
(for any intake or course).
6. If more than one referral application is received for a prospective student the first one received will be recognised.
7. Referred students in all courses must remain enrolled, pay all course fees due and have had good academic
performance on the course for at least two modules to qualify.
8. The Senior Management Team will make the final decision on referral eligibility.
REFERRAL SCHEME – TERMS AND CONDITIONS
1. About Us
1.1. This referral scheme (the “Referral Scheme”) is run by Coventry University College Limited a company
registered in England & Wales with company no. 07781274 (collectively “CU”) and whose
administrative offices for the purpose of this scheme are at Armstrong Siddeley Building, Priory Street,
Coventry, CV1 5FB].
1.2. The Referral Scheme operates by reference to each of the campuses of CU
(the “CU Campuses”), being CU Coventry, CU Scarborough and CU London.
2. Referral Scheme Reward & Objective
2.1. The Referral Scheme rewards existing students and alumni of and current applicants to CU London
with an incentive for every successful referral of a student onto a [course] with CU London.
2.2. The main objective is to reward the efforts of students and alumni in growing the student community
of CU London.
2.3. The reward under this Referral Scheme (the “Reward”) will be a £250 voucher per student referred
subject to these Terms and Conditions.
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3. Eligibility
3.1. This Referral Scheme is only available to existing students and alumni of and current applicants to
the CU London and members of the public acting in their personal capacity. It is not available to
organizations who are contracted to work as Education Agents by CU.
3.2. This Referral Scheme can be withdrawn at any time.
3.3. The application must be a direct application to CU London only and not submitted through
an education agent to be eligible for this Referral Scheme.
3.4. A maximum of [40] referrals only will be paid to an individual referrer. Only individual, natural persons
acting in their personal capacity are eligible as referrers under this Referral Scheme. Other entities
including, by way of example, limited companies are ineligible to refer any new students.
3.5. The referred student must be a first-time applicant to CU London. For example, continuing students
cannot be referred as new students, nor can undergraduate students who progress to do postgraduate
courses with CU London.
3.6. CU London staff or members of their families, and relations are not eligible to receive any Reward
under this Referral Scheme.
4. How to Claim
4.1. The referred student must indicate that they were referred to CU London by the referrer at the time
of completing their application form. Provision is made on the application for enrolment form for
this purpose.
4.2. In order to make a claim the referral student must submit their completed Student Referral Form to the
registry department either in person or via email to registry.cul@coventry.ac.uk.
4.3. CU London reserves the right to conduct the necessary checks to verify the eligibility of a claim,
and CU London’s decision on the eligibility of a claim is final.
5. Payment
5.1. Referrers determined to be eligible to receive the Reward under this Referral Scheme will be notified
by CU London Registry (registry.cul@coventry.ac.uk) and the voucher will be sent to the email
address specified on the referral form.
5.2. Subject to compliance with these terms and conditions, payment of the Reward will be issued directly
to the referrer approximately 6 weeks after the referred student’s course commencement date as
specified on the application form of the referred student, provided that the referred student’s first
instalment of tuition fees is received by CU London in cleared funds [within the first two weeks of the
course starting].
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6. Restrictions
6.1. The referred student must have had no contact with CU London within 120 days prior to
CU London’s receipt of the referred student’s application form.
6.2. In the event of the Reward being unavailable, CU London reserves the right to offer an alternative
of equal or greater value.
6.3. The Referral Scheme will not be valid with any other promotional offers or discounts unless
otherwise stated.
6.4. CU London reserves the right to amend any terms and conditions pertaining to this scheme.
The decision of CU London’s senior management on the administration of the Referral Scheme,
eligibility and the Reward is final.
6.5. This Referral Scheme will supersede all previous schemes of CU London. In the event of a conflict
with any other terms and conditions in respect of this subject matter, these Terms and Conditions
shall take precedence.
6.6. This Referral Scheme is governed by English law and is subject to the exclusive jurisdiction of the
English courts.
7. Data Protection and Disclosure of Information
7.1 Any data provided by the data subject to CU London shall be processed in accordance with
Data Protection Act 1998 (“The Act”), the General Data Protection Regulation ((EU) 2016/679)
(“GDPR”) and any superseding Data Protection Legislation.
7.2 CU London shall take all reasonable precautions to preserve the integrity and prevent any corruption or
loss, damage or destruction of personal and sensitive data and information.
7.3 All personal data collected by CU London shall only be used for the purpose of administering and
analysis of the scheme. The data shall not be further processed or disclosed without your consent.
7.4 CU London will only disclose your personal data to a third party only with your consent,
unless required for lawful purposes.
7.5 CU London will not share your data with any party outside the European Economic Area.
7.6 If we need to share your data with any party outside the European Economic Area we will
seek your consent.
7.7 CU London will store your data in our databases for a period of 26 weeks.
7.8 Unless expressly stated otherwise, these terms and conditions shall be governed by and construed in all
aspects in accordance with English law and the parties agree to submit to the exclusive jurisdiction of
the English Courts.
8 Access to information
You have the right to access information held about you by making a data subject access request by contacting
the Data Protection Officer at DSAR@coventry.ac.uk. You also have the right to apply for erasure, rectification,
withdrawal of consent, blocking and destruction of inaccurate personal data relating to you from the University
Group’s electronic and manual systems provided that the University does not have to retain the data for
legal reasons.
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CONSENT FOR THE USE OF REFERRER PERSONAL DATA BY CU
Under the terms of the Data Protection Act 1998 (“Act”), the General Data Protection Regulation ((EU) 2016/679)
(‘’GDPR’’) and any superseding Data Protection Legislation CU London requires your consent to use any personal data
for the purpose of the student referral scheme.
1. What data do we collect?
We would like to collect the following personal data:
Your name, email, phone number, programme and if applicable chosen start date of your course at
CU London.
2. Why do we need to collect this data?
It will be used for;
• Contacting via telephone the referred candidate to establish whether they want to join CU London.
• Processing this application form
• Sending you email alerts relating to this application form
3. How long we will retain your data?
We will store your data on a secure university drive for a period of 26 weeks, for CU London internal use.
4. Your Consent
Without your express permission we cannot process your application form, meaning we will be unable to
assess or respond to your application form.
Under the terms of the Data Protection Act 1998 (“Act”), the General Data Protection Regulation ((EU) 2016/679) (‘’GDPR’’) and any
superseding legislation, I consent to CU London processing and/or sharing my data for the purpose set out above.
I understand and agree that:
a) CU London will store copies of my data on their manual and electronic systems.
b) CU London will not transfer my personal data sets to a destination outside the EU.
c) CU London will disclose my personal data securely within Coventry University Group only.
d) CU London will not disclose my data to any other 3rd party organisations not specified here, without your consent and unless
required by law within and outside of the EU.
e) CU London will dispose my data securely in accordance with the Act, after the retention period specified above.
Your data will be used for the following purposes. Please indicate your consent accordingly:
I agree to my data being used for processing this application/form - Yes / No
I agree to my data being used to send me email alerts relating to this application/form - Yes / No
I agree to my data being used for analysing, within CU London, outcomes specifically in relation to this scheme - Yes / No
I also understand that I can withdraw my consent at any time by contacting registry.cul@coventry.ac.uk.
Name of Referrer:
Signature of Referrer:
Date:
In the alternative if you are unable to provide your physical signature above then you may tick the box below on the basis that you
accept by ticking the box you are providing your consent to the CU London to use your personal data for the purpose above in
accordance with the Act.
Name (please print)____________________________ Date________________________
For CU Use
Member of staff responsible for obtaining information and consent for use of student personal data:
Office Details:
Signed: …………………………………………… Date: ………………………………………..
Step three
Both
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CONTACT
Questions, comments,requests or complaints on how we handle your personal data can be sent to the Data Protection
Officer and should be addressed to:
Data Protection Officer
Information Protection Unit
Coventry University
1
st
Floor, Portal House
163 New Union Street
Coventry
CV1 2PL
Or enquiry.ipu@coventry.ac.uk
Note - Definitions:
• Referrer: The person who refers the new student to CU London. This person must be an existing student at CU London or a graduate from past
intakes of CU London [or student who is in the same intake with the student being referred]
• Referred Student: A person who has enrolled onto academic course at CU London
CU London is the trading name of Coventry University College Limited, a company wholly owned by Coventry University.
Registered in England and Wales. Registered at Priory Street, Coventry, CV1 5FB. Registration number 07781274.
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