For Office Use Only Application Number

Postgraduate Research Application Form

To The Applicant: Please complete the form in black ink in type or BLOCK CAPITALS Please ensure that you give your name as stated on your international passport Programmes normally commence on1st October, 1st February or 1st June. There is no formal closing date for applications (excluding advertised studentships), but early application is advised. If you are recognised by the UK authorities as an immigrant, a settled person or a refugee and have lived in the UK since being recognised please enclose a copy of the letter from the Home Office recognising you as a person in one of these categories. To enable your application to be considered personal data provided on your application will be entered on to the Universitys computer records. At all times use of this data will be strictly in accordance with the principles laid down by the UK Data Protection Act 1998.

PERSONAL DETAILS
SURNAME/FAMILY NAME FORENAMES TITLE (Mr/Mrs/Miss/Ms) DATE OF BIRTH

BEZAWADA ROOPESH KUMAR Mr.

Day Month Year

COUNTRY OF BIRTH NATIONALITY If you are resident in the UK, since when?

INDIA INDIAN Since Birth

Month Year

24 CONTACT DETAILS
PERMANENT HOME ADDRESS

09

1977

CONTACT/CORRESPONDENCE ADDRESS if you wish to receive all

correspondence at an address different from your permanent home address please provide details. If you are represented by one of our agents please provide their name and address here or leave it blank for agent stamp

H.No 28, 2nd Lane P & T Colony, Near Sai Baba Temple, Vijayawada, Andhra Pradesh India
Postcode Telephone
Include country code

520008 0091 8801520432 roop4u@gmail.com

Postcode Telephone
Include country code

Email

Email

(agent)

It is essential that you provide us with a clear, valid email address as this is the method we use to contact you

PROGRAMME DETAILS
AREA OF PROPOSED STUDY

Built and Natural Environment Caledonian Business School Health Sciences Psychology Education PhD ProfD ProfD HSCNP DBA Full time On Campus

Engineering and Computing Law and Social Sciences Biological Sciences Vision Sciences Other

AWARD SOUGHT

ki

MPhil ProfD by Learning contract ProfD D JWPP DAppsy DMan Part time Distance Learning February June Year: 20_ _

MODE OF STUDY

DATE OF ENTRY

Month:

October

PROJECT AREA Please give a brief descript of the project area you wish to pursue (100 words max). If applying for a studentship with a specified research student project proposal please give the studentship details, research student project title and reference number.

WORKPLACE MENTOR DETAILS - Prof D by Learning contract only

Full name Address including postcode Organisation Job Title Phone

RATIONALE FOR THE SELECTION OF MPhil/PhD, Prof.D by Learning Contract or Prof.D. Degrees Please state why you have chosen your selected Doctorate program, including a description of how it will advance your aspirations of career development and/or service delivery/re-design. Continue on a separate sheet if necessary.

Have you ever carried our an extended piece of work, project or dissertation resulting in a written report? Yes If YES, please give details:

No

If your first language is not English, you will be required to provide a valid IELTS or TOEFL certificate* without this the university will be unable to give you a final offer. *For a list of other English language qualifications accepted by the University please refer to our prospectus and website. Is English your first language? Yes No

If no, please give details of English language qualifications held and attach copies of certificates, if available. If you are currently undertaking an English language course, please give details of the course and the expected completion date. DATE OF QUALIFICATION NAME OF EXAM (e.g. IELTS, TOEFL) SCORES/GRADE

ACADEMIC QUALIFICATIONS Please give details of any courses undertaken in higher education including those where no award was achieved. Please include any pending awards.
AWARDING INSTITUTION (UNIVERSITY / COLLEGE) NAME OF DEGREE FINAL GRADE
Month

STARTED
Year

COMPLETED
Month Year

PROFESSIONAL AND OTHER QUALIFICATIONS Please give details of any professional qualifications undertaken. Please include any pending awards.
NAME OF EXAMINING BODY DETAILS OF QUALIFICATIONS (subject etc) RESULT DATE

EMPLOYMENT AND WORK EXPERIENCE Please give details of your work experience (if any), including name and address of employer(s), position held, type of work undertaken and duties. Continue on a separate sheet if necessary.
DATES: __/____ __/____ POSITION HELD: NAME AND ADDRESS OF EMPLOYER:

MAIN DUTIES AND RESPONSIBILITIES:

DATES: __/____ __/____

POSITION HELD:

NAME AND ADDRESS OF EMPLOYER:

MAIN DUTIES AND RESPONSIBILITIES:

ADDITIONAL INFORMATION / SUPPORTING PERSONAL STATEMENT Please given any other information you wish in support of your application, including information offered in lieu of formal academic qualifications e.g. relevant experience for mature students. Please include your reasons for wanting to study your choice of course at GCU. Continue on a separate sheet if necessary.

SOURCE OF FUNDING Please state how you intend to fund your proposed study. Give details of any application(s) for grant / scholarship / sponsorship you have made. If a grant/scholarship/sponsorship has already been awarded please attach a copy of supporting documentation. Please note completion of this section does not constitute an application for financial support Is this an advertised studentship? Yes No If yes, please give reference number ______________________

If you are been supported or funded by your employer please include a letter of support indicating the level of support i.e. time, finance, and/or permission to carry out work-based research Do you have a disability? Yes No

We will only use this information to provide you with details of our disability service. You can find further information regarding our disability services on our website: http://www.gcu.ac.uk/student/disability

Do you have any criminal convictions? Yes Where did you hear about GCU? Careers Office Employer Friend / Family Newspaper Open Day / Exhibition GCU Prospectus

No

Agent (please give name) Other (please state) GCU website

_____________________________ _____________________________ Other Website

Please mark if all of the following documents are included with your application (If you do not have all documents available at application stage, please provide us with the missing documents as soon as they are available)
ENCLOSED TO FOLLOW NOT AVAILABLE

Signed application form MPhil / PhD Applicants only: Research Proposal (2 4 pages) Prof.D by Learning Contract Applicants only: 2 page summary of proposed workbased project details and suggested methodology Copies of all higher education award certificates Copies of university certificates Copy of academic transcripts Two reference letters
Disclaimer The University reserves the right to make variations to the contents or methods of delivery of courses, to discontinue, merge or combine courses, and to introduce new courses. Glasgow Caledonian University processes personal information under the auspices of the UK Data Protection Act 1998. The information that you have provided here will be used for the purposes of considering and managing your application for a place in the University. For international students who are unsuccessful the University reserves the right to pass this application form to our appropriate academic partners for their consideration.

I certify that the answers and other information given in this application are correct and complete. If I am admitted to the course I undertake to observe the University regulations and to ensure payment of fees and other liabilities. Signature: ______________________________________ Date: ______________ Please send your completed Application Form and supporting documents to: Postal Address: Postgraduate Admissions Glasgow Caledonian University Cowcaddens Road Glasgow G4 0BA Email:GCUstudentships@gcu.ac.uk Fax: +44 (0)141 331 8676