Research Application Form - London School of Theology

13. Criminal ConvictionsIf you have a current (unspent) relevant criminal conviction please tick here [ ]If you tick the box above please enclose all details relating to your offence and conviction, including dates and court convicted at. This information should be sentwith this application form in a separate sealed envelope, clearly marked confidential with your name on it.Disclosure information will be handled and disposed of securely by Middlesex University and the London School of Theology in compliance with the Criminal RecordsBureau Code of Practice, the Data Protection Act and other relevant legislation.Middlesex University Policy Statements: Recruitment of Ex-Offenders to Programmes of Study or Posts (HRPS27) and Secure Storage, Handling, Use, Retention andDisposal of Disclosures and Disclosure Information (HRPS28) detail how the university will handle this information.The policies listed above are available online at http://www.mdx.ac.uk/research/degrees/routes.asp.Further information is available from the Admissions Manager, Academic Registry, Middlesex University14. References: Please give the names and addresses of two academic referees.First Referee Title: Dr/Mr/Mrs/Miss/Ms/Other:Full Name:Post Held/Occupation:Relationship to Applicant:AddressSecond Referee Title: Dr/Mr/Mrs/Miss/Ms/Other:Full Name:Post Held/Occupation:Relationship to Applicant:AddressPostcode:Telephone:Email:Postcode:Telephone:Email:15 London School of Theology Supplementary InformationPlease briefly outline your Christian experience and the types of Christian service in which you have been engaged.(Add a separate sheet if necessary)To what denomination do you belong?To what local church do you belong?Please give the name and address or email of a Pastor, Elder, Vicar orother Christian leader willing to act as a referee for you:_________________________________________________________________________________LANGUAGESWhat ancient languages can you read? [ ] Greek [ ] Hebrew [ ] Other(s)What modern languages can you read? [ ]French [ ] German [ ] Other(s)OTHER INFORMATIONHow did you hear of London School of TheologyWhy do you wish to read for this degree:Why do you wish to do so at here in particular?FAMILY DETAILSSpouse’s nameChildren’s names and dates of birthOVERSEAS CANDIDATES ONLYIf offered a place, is it your intention to have your family accompany you? [ ] Yes [ ] NoIf no, what arrangements have been made for their care in your absence?