PhD Application Form

Submitted by admin on Wed, 01/26/2011 - 17:40

1. PRELIMINARY APPLICATION FOR RESEARCH DEGREE

Degree:

PhD

EdD

MPHIL

MA/MSc BY RESEARCH

Study Mode:

Full-time

part-time

International Distance Learning

2. PERSONAL DETAILS

SURNAME: *	FORNAME: *
PERMANENT HOME ADDRESS: *
TOWN: *	POST CODE: *
COUNTRY: *	TELEPHONE: *
MOBILE:	FAX:
Email Address: *

CORRESPONDENCE ADDRESS (if different):
TOWN:	POST CODE:
COUNTRY:	TELEPHONE:
MOBILE:	FAX:
Email Address:

NATIONALITY (as stated in passport): *	PASSPORT NO: *
COUNTRY OF BIRTH: *	DATE OF ENTRY TO UK:
COUNTRY OF PERMANENT RESIDENCE: *	UK VISA EXPIRY DATE:

STATUS: *

Single

Married

DATE OF BIRTH: *

3. QUALIFICATIONS (HIGHER EDUCATION ONLY)

Institution	Title of course (eg MA Sociology)	Main subject(s)	Classification of award	Date of award	Awarding body (eg Lancaster University)
Institution 1:	Course Title 1:	Main subject 1:	Classification of award 1:	Date of award 1:	Awarding body 1:
Institution 2:	Course Title 2:	Main subject 2:	Classification of award 2:	Date of award 2:	Awarding body 2:
Institution 3:	Course Title 3:	Main subject 3:	Classification of award 3:	Date of award 3:	Awarding body 3:

ENGLISH LANGUAGE QUALIFICATION

If English is not your first language, or the language in which your higher education was conducted, please provide evidence of your proficiency in English.

Scheme (eg.TOEFL, IELTS)

Overall Score

Score for Individual components

Date of qualification

Scheme:

Score:

Listening	Listening Score:
Reading	Reading Score:
Writing	Writing Score:
Speaking	Speaking Score:

Date of qualification:

4. RELEVANT EXPERIENCE

PLEASE PROVIDE DETAILS OF ANY PROFESSIONAL, WORK OR OTHER EXPERIENCE RELEVANT TO THE APPLICATION

5. PROPOSED SOURCE OF FINANCE:

Self
Studentship	Studentship (details):
Sponsorship	Sponsorship (details):
Other	Other (details):
Note: no application will be considered without source of funding being indicated

6. PROPOSED TITLE OF RESEARCH:

PLEASE ATTACH A BRIEF SUMMARY OF YOUR PROPOSED RESEARCH PROJECT, LIMITED TO 1000 WORDS. THIS SHOULD INCLUDE HYPOTHESIS(ES), CONTEXTUALIZATION, METHODOLOGY AND BRIEF BIBLIOGRAPHY:

7. REFERENCES

PLEASE LIST THE NAMES AND CONTACT DETAILS OF YOUR TWO CHOSEN REFEREES:

REFEREE 1:
NAME:
Ref Name 1:
ADDRESS:
Ref Address 1:
TOWN:	POST CODE:
Ref Town 1:	Ref Postcode 1:
COUNTRY:	TELEPHONE:
Ref Country 1:	Ref Telephone 1:
EMAIL ADDRESS:
Ref Email 1:

REFEREE 2:
NAME:
Ref Name 2:
ADDRESS:
Ref Address 2:
TOWN:	POST CODE:
Ref Town 2:	Ref Postcode 2:
COUNTRY:	TELEPHONE:
Ref Country 2:	Ref Telephone 2:
EMAIL ADDRESS:
Ref Email 2:

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