APPLICATION FORM PAGE 1

You should complete this application as soon as possible and return to;

PLEASE PRINT CLEARLY IN BLACK CAPITALS AND BLACK INK

SECTION ONE

Title of course(s) being applied for

The Admissions Officer Leeds Arts UniversityBlenheim Walk, Leeds LS2 9AQ admissions@leeds-art.ac.uk0113 202 8000

Attach Passport Photo Below

APPLICATION FORM

Proposed year of entry

Dates not available for interview

From To

Surnam

e

Forenames

Course N

os

Student R

ef No

Education A

uthority

Entered by

Time

Received

Acknow

ledged

Interview D

ate

Qualified

DO

B verified

Exam

results received

Parental consent

Date

Outcom

e U

O C

O W

O D

NA

R

Date notified

Accepted/w

ithdrawn

OA

WD

Date

For office use

Student reference received

Yes No

YesN

o

SECTION TWO

Surname

Other names

Age on next August 31st

Date of birth (DD/MM/YY)

Title (Mr, Mrs, Miss, Ms, Other)

Mobile number

Email address

Home telephone

Correspondence address: please note that this address will be used by the University for all correspondence. Please tell us of any changes.

Home address if different from correspondence address

Postcode Postcode

SECTION THREE

Where have you lived for the last three years?

Country of residence

What is your local education authority?

Date of entry to the UK

Nationality

Name and address of your current education establishment or any you have attended over the last three years

SECTION FOUR

Postcode

SECTION FIVE - ADDITIONAL SUPPORT

I do not have a disability I have dyslexia

I am blind or partially sighted

I am deaf or hard of hearing

I use a wheelchair or have mobility difficultiesI have mental health difficulties

I need personal care or assistance

This section is designed to enable us to provide appropriate resources to assist you. The University wishes to ensure that it complies with the requirements of the Equality Act 2010. If you are a disabled person, please ensure that we know what you need so that we can make all reasonable adjustments to help you succeed.

I have a disability that cannot be seen e.g, diabetes, epilepsy or a heart condition.Please detail in your personal statement.

I have a disability, special need or medical condition that is not listed. Please detail in your personal statement.

APPLICATION FORM PAGE 2

SECTION SIX - EQUAL OPPORTUNITIES

To enable us to improve the services we offer, please complete the following information which will be used to develop and monitor equality and diversity in the University. Please tick any of the following boxes that apply to you.

FemaleMale

WhiteEnglish/Welsh/Scottish/ Northern Irish/British

31 Any other white background

3432Irish

33Gypsy or Irish Traveller

Mixed/Multiple Ethnic Group

Asian/Asian British

Other

Black/African/Caribbean/ Black British

35

39

47

44

36

40

98

45

37

41

99

38

42 43

White and Black Caribbean

Indian

Arab

African

White and Black African

Pakistani

Any other ethnic group

Not known/ not provided

Caribbean

White and Asian

Bangladeshi

Any other Black/African/Caribbean background

Any other mixed/ Multiple ethnic background

ChineseAny other Asian background

Please use the columns below to list the predicted or actual grades for examinations you have taken or are about to take. Mature students see note 2. If you have more qualifications than the space allows please continue on a separate sheet.

Subject or main area of study Level e.g. GCSE, First Diploma, Access, A Level

Examining board e.g. EDEXCEL,AQA, OCR

Date taken/ to be taken

Result/ result expected

SECTION SEVEN - QUALIFICATIONS

Office use

Verified by DateFurther information and/ or guidance required

Entry requirements met or potential to meet Yes No Not known

46

I currently receive free school meals

I am from a care/looked after background

APPLICATION FORM PAGE 3

CHECKLIST

Have you completed

All your personal details

All the details about the course for which you are applying

All the details about your present qualifications

Have you included

A passport-sized photograph

Your student reference form. See note 3.

Is your student reference form to follow

What happens now? See notes 5 and 6.

I agree to Leeds Arts University processing personal data which includes sensitive data, contained in this form and the attached student reference. I agree to the processing of such data for any purposes connected with my studies or my health and safety whilst on the premises or for any other legitimate reason. (please see note 7). I understand that this information will be provided to any other organisation which has a statutory right to receive it.

Signature of applicant

Date

Signature of parent/guardian

Date

If you are currently under eighteen, this form must also be signed by a parent or guardian

Please give details of any relevant criminal convictions which are not spent, (as defined by the Rehabilitation of Offenders Act 1974) See note 4.

SECTION EIGHT - PERSONAL STATEMENT

Please use this space for any other information to support your application. If you need more space, please add an extra sheet to your application form.

• why you wish to apply for this course(s)• skills and strengths you have to offer

• interests, voluntary activities• employment and work experience

1st Interview UO CO Re-interview required Rejection

2nd Interview Rejection

INTERVIEW NOTES - FOR UNIVERSITY USE

APPLICATION FORM PAGE 4

Interview panel

Name or initials

1st Interview

Course Date

2nd Interview

FURTHER POTENTIAL AT LEVEL APPLIED FOR

Portfolio

Reference Supportive

Excellent Good Average Weak Poor Attendance

COMMENTS

ACADEMIC ACHIEVEMENTS - IF GCSE AT GRADE ‘C’ OR ABOVE OR EQUIVALENT

Present examination results No

Expected examination results

YesNumber English

English

Maths

Maths

Number

NoYes

NoYes

NoYes

Average

NoYes Good

Poor

Communicating

Oral

Written

Quality

Quantity

Range

RESULT

Course accepted for:

Conditions of offer:

Rejection - When an applicant is rejected please tick the appropriate box/es with the reason/s for rejection

1 Portfolio of work was underdeveloped or inappropriate for the course

2 Appropriate academic/critical ability was not demonstrated

3 Did not demonstrate enthusiasm and commitment for the course

4 Withdrew at interview

5 Did not attend

6 Demonstrated appropriate aptitude but was not as strong as other candidates

7 Wrong choice of course

8 Other, please specify:

CO UO

Student reference

Name of applicant

Excellent Good Average Has some difficulties and problems

Has considerable weaknesses

Referee name

Job title

Attendance/ motivation

Further study potential

School/College/Employer/Other Name and Address

Course applied for

Date of birth

Signed

applicantS detailS

referee detailS

Section one

Section two

Please give your assessment of the applicant’s record

Please give your assessment of the applicants likely attainment in examinations/assessment specifying qualification level.i.e. level 1, 2, 3

Please be advised that this reference may be shared with the applicant, and as such is not confidential.

This form should be completed by Headteachers, Year Tutors, Careers Teachers, Art Teachers, Design Technology Teachers or (past) employers, or, if none of these is available, a person not related to you but who knows you and/or your work.

Level

Level

Level

Level

Level

Level

Level

Qualification

Qualification

Qualification

Qualification

Qualification

Qualification

Qualification

Section three

Section four

Please give your comments on the suitability of the applicant for the course, and any other details you feel may be relevant

Has the applicant any medical or physical problems (e.g. asthma, epilepsy, hearing difficulties) that we should be aware of forhealth and safety reasons? (Please note – The Data Protection Act 1988 and subsequent human rights legislation requiresthat the specific consent of applicants be obtained for this information to be included).

Yes

If Yes, please give details

No

This form may be sent with the application form, or if you prefer it to be confidential please return it separately to the following address:

The Admissions OfficerLeeds Arts UniversityBlenheim Walk Leeds LS2 9AQ

Telephone 0113 202 8000 Fax 0113 202 8001

NOTES TO ASSIST YOU IN COMPLETING THE UNIVERSITY APPLICATION FORM

NOTE ONE NOTE FIVE

Please complete all sections as fully as possible. Failure to do so may result in your application being delayed or withdrawn.

Further help if you are uncertain about which course to apply for.

If you are finding it difficult to decide about which course to apply for or need further information, please contact the Student Welfare Team on 0113 202 8111. Alternatively, you could drop in at our office at Blenheim Walk or email us at info@leeds-art.ac.uk.

NOTE FOUR

Criminal Convictions If you have a criminal conviction, which is relevant and not spent, you must disclose it. This will not automatically exclude your application, but we may want to consider it further, or ask for more information before making a decision. Relevant convictions are those against the person, whether of a violent or sexual nature, and convictions for offences involving unlawfully supplying controlled drugs or substances.

Interviews Once the Admissions Team has received your application and reference, they will write to you to explain the interview arrangements for your course (some courses interview before others, depending on the nature of the course).

You should be prepared at interview to tell us about yourself and make clear your reasons for applying. If you have a Record of Achievement or any other summary of experience, (e.g. a CV) please bring this along to the interview.

NOTE TWO

Mature Students Leeds Arts University welcomes applications from mature students. As we understand that it is often a major decision to return to study, you can contact the Student Advice Team to discuss your qualifications and experience or any other issues such as finance and childcare.

If you do not have any formal qualifications, please declare this fact on section (8) of the application form.

NOTE THREE

References - These are needed for all full-time and part-time applications

• If you are still at school or a full-time student at a Collegeof Further Education you should give the form to yourHead Teacher or Head of Department.

• If you are not in full-time education, please pass theform to the person you have nominated as your referee.

• Your reference can be submitted by email to:admissions@leeds-art.ac.uk

NOTE SIX

The Result of the Interview We endeavour to respond within 20 working days of your interview. Our letter will contain one of the following outcomes:

• An unconditional offer of a place. This is a firm offer withno conditions attached.

• A conditional offer of a place. This usually means thatyou have to achieve satisfactory exam results before youcan be offered a firm place. The letter will explain theconditions in detail.

• A reserve or waiting list place. In this case you will only beaccepted on the course if a place becomes available andyour exam results are satisfactory.

• An invitation to a further interview.

• Unsuccessful

NOTE SEVEN

The University collects information about all our staff and students for various administrative, academic and health and safety reasons. This data may be shared with funding and statutory bodies. Because of the Data Protection Act 1998, we need your consent before we can do this. If you do not do so, we will be unable to offer you a place on a course. If you require any further information about this, please contact the Student Advice office.