Graduate Diploma in Law by Distance Learning

Application invalid without supporting documents. Please read the guidance notes before completing the form.

You will need to post your references to us as soon as possible after completing this form.

1. Programme of Study: Graduate Diploma in Law by distance learning

* Start Date - October

2 Applicant's Details

* Surname		* Title
* Other Names		Other Title
* Gender	Male Female	* D.O.B	/ /

* Home Address

Address for Correspondence (if different from Home)

* Telephone
Mobile
Email

Telephone
Mobile
Email

Nationality
Country of birth
Country of permanent residence

Applicants not born in the United Kingdom please state date of last entry to the UK

/ /

3. Fees/Sponsorship * Who is expected to pay the fees (Tick as appropriate)
Employer	Applicant	Local Education Authority	Research Council
	Sponsor/Parent/Guardian	Other

Name and address to which fee invoice should be sent (if other than applicant)

If your attendance at the University will be conditional upon the agreement of your employer, please tick

4. Education

* School since the age of 11

Schools Attended - Date Started - Date Finished - Examinations Taken - Qualifications Obtained - Grade - Date

* Education since leaving school

Schools Attended - Date Started - Date Finished - Examinations Taken - Qualifications Obtained - Grade - Date

5. Employment Experience

If you are currently in employment, please complete this section. If you are currently studying and/or have no work experience, please move on to section 6

Present position

Date of appointment

Workplace address		Name and address of employing body (if different from Workplace)

Telephone		Telephone

Details of previous posts held including start and finish dates

6. References

Two references are required and these must be sent under separate cover to ITC. Please see guidance notes for further assistance

First Referee			Second Referee
* Name			* Name
* Position			* Position
* Address			* Address
* Telephone			* Telephone
* Email			* Email

7. Supporting Statement

Give a statement of your reasons for wishing to undertake this programme and any other details you feel may be relevant to your application. Indicate your main areas of interest.

8. English Language Proficiency

* What is your first language?
If your first language is not English please give your	IELTS score or TOEFL score (if applicable)
If you have not taken an English test yet, what date do you plan to take it?	/ /
What other English Language qualifications do you hold?
How many years have you studied English Language?

9. Disability

* Please select from the list below the statement which is most appropriate to you

000	You do not have a disability nor are you aware of any additional support requirements
010	You have dyslexia
020	You are blind/partially sighted
030	You are deaf/have a hearing impairment
040	You are a wheelchair user/have mobility difficulties
050	You need personal care support
060	You have mental health difficulties
070	You have an unseen disability (e.g. diabetes, epilepsy, asthma)
080	You have two or more of the above difficulties/special needs
090	You have a disability not listed above

* Does your disability mean that you have additional support needs?

Yes No

If you would like to give further details of required support needs then please do so below.

10. Planning Statistics

Ethnic origin (this information WILL NOT be made available to Admissions Tutors for selection purposes). Complete this section only if you have shown in Section 2 of the form that your area of permanent residence is in the UK. Please choose from the ethnic origin terms below which you feel most nearly describes your ethnic origin.

White		Black or Black British		Asian or Asian British		Mixed		Other
British Irish Other White		Carribean African Other Black		Indian Pakistani Bangladeshi Chinese Other Asian		White and Black Carribean White and Black African White and Asian Other Mixed		Other Ethnic Background Not Given (UK Domicile) Overseas Domicile

11. Market Research

In order to assist us to market our courses more effectively, could you please specify how you came to hear of our course?

TV Advert
Prospectus
Friends/Family
Live Locally
At University

Radio Advert
Course Leaflet
Careers Office
DMU Website
At Work
ITC Website

Press Advert (please specify)
Overseas Agent (please specify)
Careers Fair (please specify)
Other Website (please specify)
Other (please specify)
Other ITC (please specify)

12. Criminal Convictions

*You must declare if you have a relevant criminal conviction, including violence against the person or drug dealing. If you tick the 'Yes' box, the University may ask you for further details.

Yes No If yes, please give details below.

Please note that if you are convicted of a criminal offence while your application is being processed, you should notify the University.

13. Declaration

* By submitting this form I declare that, to the best of my knowledge, the information I have given above is correct in every detail. If enrolled, I agree to abide by the Regulations in force at the time.

* Tick to agree with the declaration

To avoid duplicate submissions please click once and wait for a response

Checklist for additional information to send as soon as possible

Proof of English Language proficiency (if required)
Reference forms

Rosemary Verlander-Smith
Professional Courses Manager
Ilex Tutorial College
College House
Manor Drive
Kempston
Bedford
MK42 7AB

Tel	01234 844305
Fax	01234 841 373
Email	r.verlandersmith@ilex-tutorial.ac.uk