ApplicationforAdmissiontothe.doc

Application for Admission to the Loughborough – China Partnership Programme Please complete in ENGLISH using BLOCK CAPITALS. Please return your application to: XXXXXXXXXX, Loughborough University, Loughborough, Leicestershire. LE11 3TU Title (Mr/Miss/Mrs) Forenames Family Name Date of birth Gender ?? Male ? Female Nationality Permanent Address: Tel. No. E-mail Correspondence Address: (if different) Tel. No. E-mail Agent Name and Address: Tel. No. E-mail Proposed Programme: Loughborough – China Partnership Programme School/Department of: ………………………………………………………………… Full time: (Yes / No) Yes Start Date: ……………………………… Duration of Programme: 2 Years Criminal Conviction: If you have a relevant criminal conviction* enter X in the box *Please see www.lboro.ac.uk/registry/admissions/convictions for clarification of what a relevant criminal conviction is, as well as general guidance on this question. Education/Professional qualifications: Give details of your Undergraduate studies to date. Department: University: Year Grade or % Subject Date 1st 2nd 3rd Note: Please attach a transcript of the above academic record. Awards: Give details of any awards, scholarships etc. English Language qualification: IELTS TRF Number: …………………………………………. Overall Score: ……………… Listening: ……………… Reading: ……………… Writing: ……………… Speaking: ……………… TOEFL Registration Number: …………………………………. Overall Score: ……………… Listening: ……………… Reading: ……………… Writing: ……………… Speaking: ……………… Special Needs: Please outline any special needs support you may require in order to fully un