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SI-UK Student Info Sheet

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SI-UK STUDENT INFORMATION SHEET

By completing this form, I give permission to SI-UK to enter my information into application
forms for the courses and schools listed under University Choice.

Personal Details

First Name: Family Name:


Gender: Date of Birth:
Nationality: Country of Birth:
Email: Phone Number:
Passport No. : PP start Date : PP end Date :
Permanent home address (in English):

UK address including post code (if available):

Immigration Details (for student who has studied in UK before || Leave blank if not applicable)

Date of first entry to the UK: N/A


Date of most recent entry to the UK: N/A
Do you need a visa to stay in the UK? Yes
If the answer is yes,
1. What is your visa status?
2. When is your current visa expiry?
3. Have you ever been refused a visa to the UK?

Education Background

Dates of study Name of Course Title Level of study, Final/


Institution (eg.NQF Level, Predicted
and High School, Result
Country Bachelor,
Master)

Start date:
End date:
Start date:
End date:

Start
date:
End
date: (

Work/Internship experience (if available)

Job Title:
Name of organisation:
Address of organisation:
Dates: From (MM/YY) To (MM/YY)
Duties:
References (One for UG, two for PG):

Reference 1
Title: (Mr./Ms./Mrs./Dr.) Position: Professor
Name: Phone number:
Work email:
Relationship to you: (eg. Employer, tutor, professor)
How long has the person known you?
Name of Institution/Organisation:
Address of Institution:

References 2
Title: (Mr./Ms./Mrs./Dr.) Position: Professor
Name: Phone number:
Work email:
Relationship to you: (eg. Employer, tutor, professor) PROFESSOR
How long has the person known you?
Name of Institution/Organisation:
Address of Institution:

Emergency contact Details:

Name: Relationship:
Phone number: Email:
Address (in English):

Do you have a disability?


No Yes (please state) No

Do you have any criminal convictions?


No Yes (please state) No

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