Title:*
First Name:*
Family Name:*
Date of Birth:*
Telephone:*
-
Address (During Studies):
Gender:*
E-mail:*
Passport #:
Nationality:*
Mobile:
-
Permanent Address:
Course:*
Mode of study:
Next of Kin:
Address:
Relationship:
Email:
1 - Qualification:
2 - Qualification:
English Language:
Awarding Body:
Awarding Body.:
Score:
Date of Award:
Date of Award.:
Employer:
Employer.:
Role:
Role.:
Start & End Date:
Start & End Date.:
Declaration and Data Protection
I confirm that, to the best of my knowledge, the information given on this form is correct and complete. I have read the terms and conditions of the Institute and understand
and agree to abide by the conditions and regulations set out therein. I understand that my admission will result in a ‘Student Contract’ being formed between myself and the
Institute and both parties must adhere to the terms of the contract.
The British Institute of Technology, England adheres to the Data Protection Act 1998 and information given on this form will only be used in accordance with terms of
registration. It may be necessary to pass information on this form to official UK bodies such as the Home Office to assist them in their duties. Information provided may be
shared with other organisations for the purpose of administration, careers, statistical and research purposes, e.g. the Police or UCAS.
If you are applying via a third party, for example an agent or one of our collaborative partners, it will be necessary to share information regarding your application.