APPLICATION FORM FOR ADMISSION

Please attach

your

photograph here
Briton Universal College

(Please complete this form in BLOCK letters using black ink)

PERSONAL DETAILS
Title: (Mr/Mrs etc.) Surname/Family Name (name on passport)

First Names: (name on passport)

Visa Expiry Date: Passport Number: Passport Expiry Date:

Date of Birth: Sex: Male ❍ Female ❍ Nationality

Country of Ordinary Residence:

Home Address:

Postcode/Zip:

Telephone No. : Mobile No. : Fax No. :

Correspondence Address (if different from above):

Postcode/Zip:

Address valid from: Address valid to:

Name of Next of Kin: Telephone No of Next of kin:

Next of Kin Address:

Postcode/Zip:

COURSE DETAILS
Course Name:

Course Start Date: Course End Date:

Method of Study: Full time ❍ Part time ❍

QUALIFICATIONS
Please insert educational and professional qualifications already obtained or expected.

Qualification Institution Dates of Study Class/Division/Grade.

Please forward a transcript (officially translated if not in English) of your degree results.
ENGLISH LANGUAGE
Is English your first language? Yes ❍ No ❍
If English is not your first language or if the medium of instruction at your previous University was not English, please
give details of any relevant qualifications in English language (e.g. IELTS date and score). Please forward copies of
certificates for TOEFL or IELTS tests already taken. Please note IELTS is preferred:

REFERENCES
State the details of the two people who can provided references.

Title: (Mr/Mrs etc.): First Names:

Surname: Position:

Address:

Postcode:

Telephone No. : Mobile No. :

Fax No. : Email:

Title: (Mr/Mrs etc.): First Names:

Surname: Position:

Address:

Postcode:

Telephone No. : Mobile No. :

Fax No. : Email:

EMPLOYMENT/WORK EXPERIENCE
List your employment/experience to date. You may include a copy of your curriculum vitae if this is more convenient

Name of Employer: Start Date: End Date:

Address of Employer:

Postcode: Coutry if outside of UK:

Position Held: Main Duties

Name of Employer: Start Date: End Date:

Address of Employer:

Postcode: Coutry if outside of UK:

Position Held: Main Duties

DISABILITY/SPECIAL NEEDS
Do you have a disability? Yes ❍ No ❍
If yes please specify:

EQUAL OPPORTUNITIES POLICY

At Briton Universal College our principal concern when considering applications is to recruit and select students who
are likely to complete the programme successfully and derive benefit from it. Once these requirements are met, we
regard other issues such as disability, ethnic origin, sex, marital status, number of children, beliefs relating to religion,
politics and sexual orientation as irrelevant.

KNOWLEDGE OF BRITON UNIVERSAL COLLEGE

Where did you learn about the Briton Universal College programme applied for? Briton Universal College website ❍
Other Website ❍ (please Specify)
Other ❍ (please Specify)

APPLICANT’S DECLARATION
To the best of my knowledge, the information on this application is accurate and complete. (Please note that Briton
Universal College reserves the right to refuse admission or to terminate a student’s attendance should it be discovered
that he/she has made a false statement or has omitted significant information.

Data Protection Act 1998: I agree to Briton Universal College processing personal data contained on this form, or
other data which Briton Universal College may obtain from me or other people or organisations while I am applying
for admission. I agree to the processing and disclosure of such data for any purpose connected with my studies, or my
health and safety while on Briton Universal College’s premises or for any other legitimate purpose, returns that Briton
Universal College is obliged to make to government or other agencies.

Terms & conditions apply. For details and information on our admission and refund policy, visit: www.bucollege.co.uk.

Signature Date

Please return this form, together with two letters of reference, and, where appropriate,
an English language test certificate to: ADMISSIONS, BRITON UNIVERSAL COLLEGE,
156c GREEN STREET, LONDON E7 8JQ, UNITED KINGDOM
Website: www.bucollege.co.uk Email: info@bucollege.co.uk
Telephone: +44 (0) 208 472 6710 Fax: +44 (0) 560 1161 069

PAYMENT INSTRUCTIONS
Always use your name followed by your date of birth as your reference.
Payments can be made in favour of “Briton Universal College Ltd” (in pound sterling) and sent directly to our bank ac-
count from any where in the world by using the following details:
Payments from Overseas:
Banker: HSBC Bank Plc
International Bank Account Number: GB70MIDL40011861715216
Branch Identifier Code: MIDLGB2105M
Payments within UK
Bank: HSBC Bank Plc
Sort Code: 40-01-18
Account No: 61715216

Alternatively you can make payment by sending us a cheque or a Banker’s draft.

SUPPLEIMENTARY INFORMATION
If you wish to add any further information please fill in below:

For office use only

Date Application Received: Home Office reference No.

Student ID Card No.: Student Number :

Registration Fees: Date:

Tuition Fees: Amount Paid: Date:

Receipt No. Outstanding fees