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Intercalated BSc ApplicationPlease read the guidance notes before completing the form. You may fill it in electronically, as all blank fields in this PDF version (except signature fields) are editable. The completed form can then be saved electronically before printing and sending. Or, alternatively, please complete using black ink and BLOCK CAPITALS. Please make sure you sign the form where necessary. UCL Prospective Students (enquirers and applicants) Privacy Notice can be viewed at: www.ucl.ac.uk/legal-services/privacy/ ucl-prospective-students-enquirers-and-applicants-privacy-notice

For office use App. No. Date of receipt H/O/E/X Initials

1. Surname/Family name (as in passport) 3. Title (Mr/Mrs etc.)2. First name/s (as in passport)

4. Sex ()

FemaleMale

5. Nationality

6. Date of Birth 7. Passport issue date 8. Passport expiry date 9. Passport number

Section 1Personal details

Completed application forms should be sent by hard copy to: Undergraduate Admissions, Access and Admissions, Student and Registry Services, UCL, Gower Street, London, WC1E 6BT, United Kingdom.

Other

11. Country of ordinary residence10. Country of birth

12. Home address 13. Correspondence address (if different)

Postcode

Email

Mobile tel

Home tel

Dates when address is valid from:

Postcode

Email

Mobile tel

Home tel

to:

LONDON'S GLOBAL UNIVERSITY

Intercalated BSc Application

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Section 2Intercalated BSc for which you wish to apply, fee status and visa status

Applicants can select up to two programmes, please make sure you list your choices in order of preference.

16. What is your fee status at your home university? ()

Fee status

EU UK Overseas

Visa status

17. Do you require a student visa to study in the UK?

NoYes

18. Do you currently hold a Tier 4 Student Visa from your home institution?

NoYes

BSc choice

14. First choice BSc

15. Second choice BSc

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Section 3Education

19a. Qualifications already obtained

Detail your qualifications already obtained ensuring you start with the most recent. Please remember to include GCSE and A levels. Where appropriate include professional qualifications. Please do not convert qualification titles or grading systems to another system. Please enter in format for your institution e.g 13/20, 85% etc.

19b. Qualifications currently being taken

Detail qualifications yet to be awarded. Where appropriate include professional qualifications. Please do not convert to another system. Please enter in format for your institution e.g 13/20, 85% etc. Remember to attach your medical degree transcript demonstrating your progress so far when finally submitting your application.

Name of College/University/Awarding Body (state country if outside the UK)

Start date (Month/Year)

End date (Month/Year)

Qualification(e.g. A level GCSE)

Overall class/grade/GPA

Qualification Title: Subjects studied and grades obtained so far

Name of College/University/Awarding Body (state country if outside the UK)

Start date (Month/Year)

End date (Month/Year)

Qualification(e.g. BA, BSc)

Overall class/grade/GPA

Degree Title: Subjects studied and grades obtained so far

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Section 4Funding, knowledge of UCL and disability/special needs

20. How will you be financing your studies at UCL? Please () one or more boxes.

Please refer to www.ucl.ac.uk/scholarships for information.

Funding

Studentship/scholarshipPersonal/Family resources Loan

Other (please specify)Sponsorship

21. If you hold or are intending to apply for funding please state:

Name of award

Name of award

Value and duration of award

Value and duration of award

Has it been awarded ()

Has it been awarded ()

Yes

Yes

Decision pending

Decision pending

Please note, completion of this section does not constitute an application for funding.

UCL website

Knowledge of UCL

22. Where did you learn about the UCL programme applied for? Please () or write in one or more boxes.

Other academic staff

Prospectus/departmental brochure

Employer

Other website (please specify)

Former UCL graduate Student recruitment/ exhibition fair

UCL academic staff

Careers centre Newspaper/recruitment guide/magazine advertisement (please specify) Other (please specify)

British Council

Disability/special needs

23. Do you have a disability ()

Yes No

Please also complete the disability and ethnic origin monitoring form enclosed. Any information on disability will be passed (in confidence) to UCL’s Disability Co-ordinator. If you have a disability that may require reasonable adjustments to be put in place, you must independently contact the Disability Co-ordinator to discuss your needs.

Employer

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Section 5Supplementary personal statements

Please provide a personal statement for each of your iBSc choices. Remember to describe your academic interests and reason for applying for your chosen programme(s)

24a. Personal statement for first choice

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24b. Personal statement for second choice

Section 5 (continued)Supplementary personal statements

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Section 6Referees, Equal Opportunities Policy and Applicant's declaration

Referees

25. Give details of the two people who have provided the references that you are returning with this application.

At least one of your referees should be a tutor/lecturer acquainted with your academic ability. Referees should not be family members or friends.

Equal Opportunities Policy

At UCL 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. Please note UCL is required to supply relevant information to the Higher Education Statistics Agency.

Postcode Postcode

Email

Tel Tel

Name

Position

Address

Name

Address

Position

Email

Intercalated BSc Application

Continued over

26. Applicant's declaration

To the best of my knowledge, the information on this application is accurate and complete. (Please note that UCL 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. If you are offered a place, you will be required to provide evidence of your qualifications.)

UCL Prospective Students (enquirers and applicants) Privacy Notice can be viewed at: www.ucl.ac.uk/legal-services/privacy/ucl-prospective-students-enquirers-and-applicants-privacy-notice

Please return this form, together with the following documents (please use the boxes to check that you have included everything): 1) two letters or reference 2) an academic transcript, (please refer to guidance notes) 3) a letter confirming that your home institution can release you for this period of study 4) the disability and ethnic origin monitoring form

send to: Undegraduate Admissions, UCL Student & Registry Services, UCL, Gower Street, London WC1E 6BT

Signature Date

Section 7.1Reference form for iBSc study

Applicant's name Programme of study

The above student is applying to UCL for admission to a graduate programme of study. To assist us in the selection process, we should be most grateful if you could complete the four sections of this form.

1. (a) How long have you known the applicant? (b) In what capacity do you know the applicant?

(c) Cohort measure

If you are an academic referee, please indicate the cohort against whom you are measuring the applicant (e.g. number of students/all students in current year/all students you have ever taught):

Intellectual ability 1 2 3 4 5 6 7 8 9 10 Unable to comment

Motivation 1 2 3 4 5 6 7 8 9 10 Unable to comment

Written communication skills 1 2 3 4 5 6 7 8 9 10 Unable to comment

Oral communication skills 1 2 3 4 5 6 7 8 9 10 Unable to comment

Ability to organise workload 1 2 3 4 5 6 7 8 9 10 Unable to comment

Originality 1 2 3 4 5 6 7 8 9 10 Unable to comment

Overall assessment of applicant 1 2 3 4 5 6 7 8 9 10 Unable to comment

2. Assessment

Please assess the applicant on a scale of 1 (lowest) to 10 (highest) in relation to the following criteria by circling the appropriate number:

I do not recommend this applicant for the above programme of study.

3. Comments (see overleaf)

4. Recommendation ()

I strongly recommend this applicant for the above programme of study.

I am unable to comment.

I recommend this applicant for the above programme of study.

Contact details

Name

Tel

Signature

Email

Position

Date

Please turn over

3. Comments (from overleaf)

We would be grateful if you would comment in writing on the applicant including if they have not yet graduated, what final degree classification or grade he/she is expected to obtain and any further relevant information, for example performance in the workplace or suitability for the programme applied for. (Continue on a separate signed letter on headed paper if preferred.)

Undergraduate Admissions, UCL Student & Registry Services, University College London, Gower Street, London, WC1E 6BT, United Kingdom

Thank you for your co-operation in completing this form. Please enclose this form and any letter in an envelope and sign across the seal before returning it to the applicant. Your reference will be treated in the strictest of confidence. For further information about UCL’s reference policy please visit this link: www.ucl.ac.uk/srs/staff-support/policy/references

Section 7.2Reference form for iBSc study

Applicant's name Programme of study

The above student is applying to UCL for admission to a graduate programme of study. To assist us in the selection process, we should be most grateful if you could complete the four sections of this form.

1. (a) How long have you known the applicant? (b) In what capacity do you know the applicant?

(c) Cohort measure

If you are an academic referee, please indicate the cohort against whom you are measuring the applicant (e.g. number of students/all students in current year/all students you have ever taught):

Intellectual ability 1 2 3 4 5 6 7 8 9 10 Unable to comment

Motivation 1 2 3 4 5 6 7 8 9 10 Unable to comment

Written communication skills 1 2 3 4 5 6 7 8 9 10 Unable to comment

Oral communication skills 1 2 3 4 5 6 7 8 9 10 Unable to comment

Ability to organise workload 1 2 3 4 5 6 7 8 9 10 Unable to comment

Originality 1 2 3 4 5 6 7 8 9 10 Unable to comment

Overall assessment of applicant 1 2 3 4 5 6 7 8 9 10 Unable to comment

2. Assessment

Please assess the applicant on a scale of 1 (lowest) to 10 (highest) in relation to the following criteria by circling the appropriate number:

I do not recommend this applicant for the above programme of study.

3. Comments (see overleaf)

4. Recommendation ()

I strongly recommend this applicant for the above programme of study.

I am unable to comment.

I recommend this applicant for the above programme of study.

Contact details

Name

Tel

Signature

Email

Position

Date

Please turn over

3. Comments (from overleaf)

We would be grateful if you would comment in writing on the applicant including if they have not yet graduated, what final degree classification or grade he/she is expected to obtain and any further relevant information, for example performance in the workplace or suitability for the programme applied for. (Continue on a separate signed letter on headed paper if preferred.)

Thank you for your co-operation in completing this form. Please enclose this form and any letter in an envelope and sign across the seal before returning it to the applicant. Your reference will be treated in the strictest of confidence. For further information about UCL’s reference policy please visit this link: www.ucl.ac.uk/srs/staff-support/policy/references Undergraduate Admissions, UCL Student & Registry Services, University College London, Gower Street, London, WC1E 6BT, United Kingdom

Disability and ethnic origin monitoring form

Surname/Family name First names

Please note that this form will not be passed to any admissions tutor. UCL is required to supply this personal information to the Higher Education Statistics Agency.

If you have a disability that may require adjustments to be put in place, you must contact UCL’s Disability Co-ordinator, email: disability@ucl.ac.uk; telephone: +44 (0)20 7679 0100; fax: +44 (0)20 7916 8530; address: UCL Student & Registry Services, University College London, Gower Street, London WC1E 6BT.

Disability (please () one box)

No disabilityA

You have a social/communication impairment such as asperger’s syndrome/other autistic spectrum disorderB

You are blind or have a serious visual impairment uncorrected by glassesC

You are deaf or have a serious hearing impairmentD

You have a long standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease or epilepsyE

You have a mental health condition such as depression, schizophrenia or anxiety disorderF

You have a specific learning difficulty such as dyslexia, dyspraxia or AD(H)DG

You have physical impairment or mobility issues, such as difficulty using your arms or using a wheelchair or crutchesH

You have a disability, impairment or medical condition that is not listed aboveI

You have two or more impairments/and or disabling medical conditionsJ

Information refused97

Are you currently or have you previously been in receipt of a UK disabled student’s allowance? Please () one box

NoYes

Ethnicity (please () one box)

White10

16

21

22

29

31

Gypsy/Traveller

Black or Black British – Caribbean

Black or Black British – African

Other Black background

Asian or Asian British – Indian

32

33

34

Asian or Asian British – Pakistani

Asian or Asian British – Bangladeshi

Chinese

Please return this form with the rest of your application to: Undergraduate Admissions, UCL Student & Registry Services, University College London, Gower Street, London, WC1E 6BT, United Kingdom

Other Asian background39

41

42

43

49

50

Mixed – White and Black Caribbean

Mixed – White and Black African

Mixed – White and Asian

Other Mixed background

Arab

80

98

Other ethnic background

Information refused

PR

_SR

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