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Part Time Application Form
How do I use this application form?
Please read the help for each section before completing the form. Once you have completed it click the 'send application' button at the bottom of the page. Your application will then be processed and you will receive a confirmation e-mail.

In order to complete this form you will need to provide copies of the following documents:
  1. A copy of your highest relevant qualification or a CV detailing your work experience if you do not have relevant qualifications.
  2. A copy of your English Language Qualification if applicable (i.e. IELTS, TOEFL or equivalent).
  3. A reference letter from your current employer / tutor to support your application.
If you require assistance in completing this form or require a paper version please contact us at:
University College Birmingham, Summer Row, Birmingham B3 1JB.  Tel: 0121 604 1040.  Fax: 0121 608 1166.  e-mail: ptadmissions@ucb.ac.uk
1. Choose course Help
   Year of Entry 
2. Personal details Help
Name
 

Address
 
Town
County
Postcode  
Country
Tel Number (home)
Tel Number (mobile)  
Email Address
Date of Birth  
   
 
What is your nationality?  
Have you been resident in the UK for the last three years for other than educational purposes? Yes No
If No, please enter your date of entry to the UK        From which country? 
3. Disabilities Help
If you have any disabilities or medical conditions we should know about, please give details below:
4. Learning requirements Help
If you have any specific learning requirements, please give details below:
5. Education Help
      From   To    
School/College/Institution Town/City (MM) (YYYY) (MM) (YYYY) Qualification
For example:. My school   My town   09   1993   07   1999   A Level
       
       
       
       
       
Other Qualifications which you have already achieved (except those obtained at school).
  I have NO other qualifications
      Date of Award    
Title of Qualification Results (MM) (YYYY) Awarding Body
For example:. My school   A+   09   1993   NCFE
     
     
     
     
     
6. Employment/Work experience Help
Please give details of employment history/work experience and training.
  I have NO work experience
    Name of   From   To    
Job title and nature of work/training Organisation (DD) (MM) (YYYY) (DD) (MM) (YYYY) Full- or Part-time
For example: Sales assistant working in a shop   Shop name   23   09   2008   31   03   2009   Part-time
               
               
               
               
               
               
7. Personal Statement Help
We would like to know more about you and have left this space for you to write briefly about other relevant experience and additional information that may help your application.
 
How did you find out about University College Birmingham and the courses available? 
If Radio or Newspaper advert please specify which station/newspaper  
Have you attended a University College Birmingham Open Day? Yes No
I am already a UCB student? Yes No
My college has a progression agreement with UCB? Yes No
8. Criminal convictions Help
Do you have any criminal convictions? Yes No
If Yes, please outline details here, including dates of conviction
9. Supporting Documents Help
Please note on the next page you will be asked to provide the following documents:
  1. A copy of your highest relevant qualification or a CV detailing your work experience if you do not have relevant qualifications.
  2. A copy of your English Language Qualification if applicable (i.e. IELTS, TOEFL or equivalent).
  3. A reference letter from your current employer / tutor to support your application.
10. Declaration Help
I confirm that the information given on this form is true, complete and accurate and no information that has been requested has been omitted.
I undertake to be bound by the University College Birmingham's General Student Regulations and I also give consent to the University College Birmingham for the processing of my data for administrative purposes as required (in accordance with the Data Protection Act 1998). I accept that if I do not comply with these requirements, the University College Birmingham has the right to cancel my application and I shall have no claim against University College Birmingham.
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