0

No known disability

1
You have a social/communication impairment such as Aspergers
syndrome/other autistic spectrum disorder

2
You are blind or have a serious visual impairment uncorrected
by glasses

3

You are deaf or have a serious hearing impairment

4
You have a long standing illness or health condition such as
cancer, HIV, diabetes, chronic heart disease, or epilepsy

5
You have a mental health condition, such as depression,
schizophrenia or anxiety disorder

6
You have physical impairment or mobility issues, such as
difficulty using arms or using a wheelchair or crutches

7
You have a specific learning difficulty such as dyslexia, dyspraxia
or AD(H)D)

8
You have physical impairment or mobility issues, such as
difficulty using your arms or using a wheelchair or crutches

9
You have two or more impairments and/or disabling medical
conditions

GUIDANCE NOTES FOR APPLICATION FORM



This application form is intended only for those applying for the Education for Sustainability (EfS) Programme
through distance learning. If you intend to apply for the full-time course you must do so through UKPass at
www.ukpass.ac.uk

Closing Dates for Applications
The University has no formal closing dates for receiving applications but you should aim to apply as early as
possible. Some of our courses are very popular and places often become filled early in the year.

Scholarships
If you wish to apply to be considered for a scholarship please go to the following web pages for further
information.
Home and EU students: www.lsbu.ac.uk/fees/financialHelpLSBU.html
International students: www.lsbu.ac.uk/fees/international.html


Completing the Application Form
Please complete this form in black ink using block capitals. Complete ALL SECTIONS of the application
form. The application form is your chance to sell yourself to us and you should complete it yourself.
We are unable to accept application forms completed by anyone but the applicant.


Section 1: PERSONAL DETAILS
Please complete this section with your personal details as they are given
on your passport or birth certificate. It is important that you include
legible email, mobile and telephone details.

Section 3: DISABILITY/SPECIAL NEEDS
Please enter in the box the code from the list of statements below which
is most appropriate to you. The information you provide does not affect
any decision regarding your academic suitability for a course and is
treated confidentially. This information will help the university to provide
the best available support for you.






























Section 4: CARE LEAVERS
We are proud to have achieved the Frank Buttle Trust quality mark. The
Trust has developed a Commitment to Care Leavers in Higher
Education, which provides a charter through which universities and
colleges can demonstrate their commitment to help. If you are a care
leaver tick the appropriate box.

Section 5: CRIMINAL CONVICTIONS
The University has a duty of care towards its students and staff. You are
therefore required to declare whether or not you have been convicted of
any criminal offences, other than minor motoring offences (three penalty
points or less) and offences considered as spent under the
Rehabilitation of Offenders Act 1974. If you tick yes you should give
further information about your conviction. Declaring a criminal
conviction will not automatically affect your admission to the University.
If you receive a conviction after applying and before commencing your
course, you must inform the University Admissions team immediately.
Please note that health programmes are exempt from the
Rehabilitation of Offenders Act. This means you must declare any
convictions even if they are spent. A Criminal Records check will be
carried out on all successful applicants to these courses. The
information supplied will be treated in strict confidence.

Section 6: PROGRAMME OF STUDY
Please read the current Prospectus carefully before filling out this section
ensuring you have the correct Award = level of study (i.e. MSc), Course
Title, Year of Entry (indicated entry point yr 1,2,3 or 4) and mode of
study (full or part time).

If you have more than one choice of courses you will be considered
for your first choice, if you are unsuccessful, you will be considered
for your second choice and will be notified by email/post.

Part-time Study
If you wish to study part-time please check the prospectus to verify that
this mode of study is available.
Overseas applicants from non EU countries should note that the terms
of entry into the UK will normally prevent you from seeking employment
and it will not be possible for you to register to undertake a course on a
part-time basis.


Section 7: FEE STATUS
The University is required to assess your fees status, please answer all
questions in this section and give details of who you expect to pay your fees.
This section of the application will be used to make an informal fee
assessment and should be fully completed.

Section 8: HAVE YOU PREVOUSLY STUDIED IN THE UK?
If you have previously studied in the UK please complete all details.

Section 9: CURRENT STUDIES
Please fill in relevant information as required. If you are currently studying a
degree or postgraduate programme then please provide copies of
transcripts.

Section 10: EDUCATIONAL QUALIFICATIONS
Please give details of examinations already passed including professional,
postgraduate, degree, diploma, A levels, GCSE or any secondary school
qualifications starting with the most recent first and provide copies of
certificates and transcripts (including explanation of the marking system). If
these are in a language other than English please include an official
translation. These need to include title of course undertaken. You will be
expected to bring original documentation when you enrol with us.

Section 12: ENGLISH LANGUAGE
For applicants whose first language is not English you must have an English
language qualification before starting a programme of study at London South
Bank University. Acceptable English language qualifications can be found on
our website www.lsbu.ac.uk/international/english- Requirement.shtml

If you have already taken one of the relevant tests, please enclose your test
score report. Applicants with a low language score may find they may need
additional language support before and during their studies. London South
Bank University offers summer courses in English (Pre-study English
Course). If you are interested, further information can be found on our
website www.lsbu.ac.uk/bcim/progs/fgs/pse/

Section 13: WORK EXPERIENCE
Please include all your work experience paid or unpaid, full or part time
which is relevant to the course.

Section 14: PERSONAL STATEMENT
Please write your personal statement yourself, in your own words. We want
to know about your experiences and your interests. If you have been out of
education for a while please outline any relevant experiences that may be
taken into consideration in lieu of formal qualifications.

Section 15: HOW DID YOU HEAR ABOUT THE COURSE AT
LONDON SOUTH BANK UNIVERSITY?
Please indicate how you heard about us.

Section 16: DECLARATION
Any material omissions or falsehood in your application may result in the
cancellation of your application or registration.

Data Protection Legislation
Many students apply to us from overseas but have friends or family in the
UK who contact the University on the students behalf. If you wish to
authorise a friend or family member to request and receive information on
your behalf please email international.admissions@lsbu.ac.uk and
request our Data Protection Authorisation form.







Checklist/Documents Required*
When you have completed the application please return it to the address
printed on the form along with:
Photocopy of your current passport.
Photocopies of all your educational certificates with translated copies
where necessary.
Two written / typed references stamped with an official stamp or on
headed paper from an academic / employer who can recommend your
suitability as a student.
An IELTS, TOEFL or Cambridge certificate if English is not your first
language.

If you are not able to provide all these documents at the time of your
application do not worry; we can make an initial decision based on the
information you provide, however you may be asked to provide the
additional documents at a later date.
*Please note: DO NOT send us original documents at this stage.

Assessing your Application
Your application will be assessed on the basis of the information you enter
on your application form and the content of your references. It is therefore
important that you complete this form carefully so it is both accurate and
legible and that you explain clearly why you wish to take the particular
course, type of experience you have and why you think you should be given
a place.

The University encourages applications from those with disabilities.
If you require further information please go to our website
www.lsbu.ac.uk/learningsupport/disabilities/aboutus.shtml

The Decision Process
Applications are processed by our Admissions Team at the University.
However, if you wish to apply for second or third year entry, your
application will be forwarded to an Admissions Tutor / Course Director
for consideration.

A formal decision letter notifying you of the outcome of your application
will be emailed or posted to you if you do not have an email address.

Conditional Offer
If you hold a conditional offer you will need to provide proof of meeting these
conditions to the admissions office in the form of photocopied
documentation.

Unconditional Offer
If you hold an unconditional offer you need to confirm your place by returning
your Acceptance Reply form.

Reply Acceptance Slip
You must return your reply slip confirming your acceptance of the offer to
study at London South Bank University.

International Students -
Confirmed Unconditional Place
As soon as you have firmly accepted an unconditional place with us you will
be required to pay a deposit towards your course.

On receipt of your deposit you will be issued with a Confirmation of
Acceptance for Studies certificate which you will need when applying for
your visa www.bia.homeoffice.gov.uk/studyingintheuk/



Application Form

Please complete this application form in block capitals and in black ink
Application No:

2. ARE YOU AN INTERNATIONAL STUDENT
THAT EITHER HAS OR REQUIRES A STUDENT
VISA
Yes No




3. DISABILITY/SPECIAL NEEDS SEE GUIDANCE
Do you have a disability?
Please select the appropriate code: Select one


4. CARE LEAVERS:
If you are a care leaver please tick the box

5. CRIMINAL CONVICTIONS
Do you have a criminal conviction? Select from the list



DECISION BY ADMISSIONS TUTOR OFFICE USE ONLY
Date Received (dd/mm/yy): Faculty: Select from the list
LSBU Course Code: Year: Select one
Course Offered:
Conditional Offer: Yes No
The conditions of the offer are:
1.
2.
3.
Unconditional Offer: Yes No
Reject:: Yes No
If rejected, please state reasons and/or possible alternative course.
Refer to Cambridge Education Group
Exemptions given: (Please state)
Academic Name :
Academic signature: Date (dd/mm/yy):





1. PERSONAL DETAILS
Title: Mr/Ms/Miss/Mrs etc: Select one
Surname/Family name:
First name(s):
Correspondence /Agent address:
Country: Postcode:
Telephone number: (including STD code)
Day: Evening:
Mobile No:
E-mail:
Home address (if different):
Country: Postcode:
Sex: Select one
Date of birth (dd/mm/yy): 12/12/11
6. PROGRAMME OF STUDY

Award Title of Course
Course
Start Date
Point of
Entry
Course
Code
FT/PT
Choice 1 Select one Select one Select one FT
Choice 2 Select one Select one Select one FT
7. FEE STATUS

(i) Country of Birth:

(ii) Nationality (as on Passport):
(iii) Passport No:
Are you a British or EU Citizen Yes No
If yes please complete this section, if no please go to section 8.
(iv) If you have ever lived outside (or were born outside) the UK/EU
please answer the following:

(a) Please state the time spent outside the UK/EU
Dates(dd/mm/yy) From: To:
(b) Have you been granted Humanitarian Protection on the grounds of
refused asylum application or have you been granted Refugee status?

Yes (If Yes, date granted): No

(c) Is your stay in the UK/EU for education purposes, ie a student visa?
Yes No

(d) Have you been granted indefinite leave to remain or enter?
Yes Date granted (dd/mm/yy): No

(e) How will your fees be paid?
Self financing Sponsored by Family
UK Government Student Loan/Bursary
Other sponsor (please specify)














8. HAVE YOU PREVIOUSLY STUDIED IN THE UK
Have you previously studied in the UK? Yes No If yes please select the total time spent studying: Select one
Please state each School/College/University you have attended in the UK and the name of the course you studied.
1. Name of Institution:
2. Name of Institution:
3. Name of Institution:
4. Name of Institution:
5. Name of Institution:
Course(s):
Course(s):
Course(s):
Course(s):
Course(s):
If you have been a student at London South Bank University please state your Student ID No.
Attended (dd/mm/yy) from: to:
9. CURRENT STUDIES
(IF YOU ARE CURRENTLY COMPLETING A COURSE PLEASE COMPLETE THIS SECTION AND ATTACH TRANSCRIPTS)
Course Title
Awarding Body/University:
City/County: Country:
Start Date of Course (dd/mm/yy) : Expected Completion Date (dd/mm/yy):
10. EDUCATIONAL QUALIFICATIONS
PLEASE STATE THE MOST RECENT FIRST AND ATTACH COPIES OF ALL CERTIFICATES AND TRANSCRIPTS
Name of
University/College/ School
attended and Address
Qualification Subject
Length
of course
Date
Awarded
(dd/mm/yy)
Grade
Select one Select one
Select one Select one
Select one Select one
Select one Select one
Select one Select one
Select one Select one
Select one Select one
Select one Select one
Select one Select one
11. HIGHEST LEVEL OF QUALIFICATION
Please state what you expect to be your highest level qualification at the time of enrolment.
Title: Level: Please select from list Date Achieved (dd/mm/yy):
12. ENGLISH LANGUAGE
If your first language is NOT English, please state your language:
If you have not taken an English test yet, what date do you plan to take the test:
If you have taken an English Exam please provide the details IELTS / TOFEL score: Date taken (dd/mm/yy) :
OTHER Please name Score Date taken (dd/mm/yy) :










13. WORK EXPERIENCE Yes No
(PLEASE GIVE DETAILS OF WORK EXPERIENCE, TRAINING AND EMPLOYMENT, MOST RECENT FIRST)
or ATTACH A COPY OF YOUR CV
Start Date
(mm/yy)
End Date
(mm/yy)
Fulltime/
Part-time
Post Held Organisation Name Brief description of duties
Select one
Select one
Select one
Select one
14. PERSONAL STATEMENT
(PLEASE WRITE HERE OR ATTACH AS A SEPARATE DOCUMENT)















15. HOW DID YOU HEAR ABOUT THE COURSE AT LONDON SOUTH BANK UNIVERSITY
Please indicate how you heard about the course you have applied for. This will enable us to plan further publicity more effectively.
Family Friend Internet Exhibition Open Day Agent
Other (please specify):
16. DECLARATION
Under the Data Protection Act 1998, the information you supply will be held in strict confidence for the purpose of ascertaining your suitability for
your chosen course of study. In the event that you become a registered student with the University your data will form the basis of your student
record. I confirm that the information given in this form is correct and complete. I understand that the University reserves the right to withdraw any
offer or cancel a registration made on the basis of the information which proves to be false or misleading.
Signature of Applicant (electronic/text): .

Name of Applicant: Date (dd/mm/yy):

(Overseas Applicants)
If your application is unsuccessful, we may wish to forward the information contained within this application to academic partners Cambridge Education
Group (CEG) for consideration for a Foundation Programme for International Students. If you do not want us to do so, please tick this box
CHECKLIST/DOCUMENTS REQUIRED

Have you

1. Completed the application form in full



2. Attached copies of all transcripts/certificates (evidence of qualifications)

3. Copy of English Language evidence (IELTs/TOFEL/ other) - (overseas applicants)

4. Attached completed reference forms with official stamp or on headed paper signed and
dated


5. Attached documentary evidence of your settlement status in the UK or EU ( overseas
applicants )


6. Copy of passport / Travel Document (overseas applicants)
7. Copies of ALL UK Visas attached ( overseas applicants )


Please return this completed application form with
references to:
leacockv@lsbu.ac.uk

Telephone: 020 7815 6100 Fax: 020 7815 8273 Email: leacockv@lsbu.ac.uk



ADDITIONAL INFORMATION
(PLEASE WRITE HERE ANY INFORMATION YOU HAVE NOT BEEN ABLE TO INCLUDE WITHIN ANY OF THE
SECTIONS ABOVE)