UEA London prospectus 2012–2013 - University of East Anglia

INTO g UEA LONDON
Application form 1 of 4
Application form 1 of 4
Please complete all relevant sections of this form in BLOCK Capitals and in BLACK INK and
return it to your local representative or directly to the INTO Admissions Office at least one
month before your intended start date.
Representative’s stamp
Please send to
INTO UEA London Admissions, 1st Floor, 96-98 Queens Road, Brighton, BN1 3YB, UK
Fax +44 (0)1273 328595 or +44 (0)1273 329746 Email: ukadmissions@into.uk.com
You can also apply online at www.intohigher.com/uea-london/apply
Students wishing to apply for the Masters programmes offered by the London
Academy of Diplomacy should send their completed application form to UEA London
or apply online at www.uea.ac.uk/london
Section 1
Student details (You must complete this section accurately otherwise your visa application may be affected)
Title (Mr/Mrs/Ms)
Family name
Contact details
Telephone and fax numbers in country of residence (including international code)
First given name
Second given name
Preferred name
Tel
Mobile telephone (inc. intl. code)
Email address
Fax
Gender M F
Current age
Correspondence email (if different from above)
Correspondence address (if different from above)
Date of birth —— / —— / —— (dd/mm/yy)
Student’s nationality (must be completed, necessary for visa application)
City
Postcode
Permanent country of residence
Home address
Home address (you must complete this accurately as it may affect your visa application)
Country
What type of visa do you intend to apply for?
Adult student visa Student visitor visa No visa
Passport details
City
Postcode
Name as written on passport
Passport number
Country
Passport expiry date
—— / —— / —— (dd/mm/yy)
Section 2
Parent/guardian or sponsor details (Information we need to send financial documentation and reports)
Title (Mr/Mrs/Ms)
Family name
Other names
Relationship to student
Postcode
Country
Telephone (inc. intl. code)
Email address
Contact address
City
61