INTO London 20162017
Application form 1 of 2
Education counsellor's stamp
Please complete all relevant sections of the application form in full.
You should return your application pack to your local education counsellor or directly to the INTO Admissions Office
at least one month before your intended start date.
Counsellors name:
Please send to: INTO London Admissions, One Gloucester Place, Brighton, East Sussex, BN1 4AA, UK
T: +44 1273 876040 | Education counsellor: ukadmissions@into.uk.com | All other enquiries: ukes@into.uk.com
Counsellors email:
You can also apply online at: www.intohigher.com/into-london/apply
Section 1 Student details (You must complete this section accurately otherwise your visa application may be affected)
Title (Mr/Mrs/Ms)
Do you have or are you applying for permanent residence in the UK?
Yes
No
Family name
Are you a US citizen or a US permanent resident?
Yes
No
Other names
Do you have dual nationality status?
Yes
No
Gender
Date of birth
//
(dd/mm/yy)
Current age
What type of visa do you intend to apply for?
Student Tier 4 visa
If yes, please provide full details
Permanent country of residence
Short-term study visa
No visa
Students home address (you must complete this accurately as it may affect your visa application)
Name as written on passport
Passport number
City
Nationality / citizenship
Postcode Country
Students telephone numbers in country of residence (including international code)
Tel Mobile telephone
Students email address
Section 2
Parent/Spouse/Family member and Sponsor details
Title (Mr/Mrs/Ms)
Postcode Country
Family name
Telephone (including international code)
Other names
Email address
Relationship to student
How do you intend to fund your studies?
Contact address
Self
Family
Employer*
Sponsor*
*Name of employer/sponsor:
City
Section 3
INTO course selection
Academic programmes
Graduate Diploma programme
International Foundation programme
Business Administration
Accounting and Finance
Art, Design and Media
Business, Management and Law
Hospitality, Events and Tourism
Science and Engineering
Please specify start date
Sep 2016 (3 term)
Jan 2017 (3 term)
English language courses
Please specify start date
English for University Study
Jun 2016 (4 term)
Sep 2016 (4 term)
Sep 2016 (3 term)
Jan 2017 (3 term)
Sep 2016
Jan 2017
Start date
Apr 2017
End date
Jun 2017
(dd/mm/yy)
Please specify number of terms of English (1 term minimum)
Proposed undergraduate or postgraduate programme (Must be completed for visa purposes)
Please provide the name of the degree programme and University you intend to progress to:
Section 4
Students education history
Please give full details of your current or most recent school, college or university. For visa purposes
we must have a full history of your academic background. Please ensure any gaps in your education
are fully explained either on the application form or enclosed with your supporting documentation.
All official institution transcripts, latest available results or forecast results must be submitted in
English. See page 70 for details of documentation you must submit as part of your application.
I confirm that I have included full details of all of my academic studies and do not have any
plans to study further prior to enrolling on my programme with INTO. I understand that failure
to provide full information on my academic studies may result in a visa refusal and/or dismissal
from the Centre.
Institution name
Dates of study
//
Date you received (or will receive) your certificate
Highest educational qualification name
//(dd/mm/yy)
//(dd/mm/yy)
to
Language of instruction
Institution city/town
Postcode Country
Email address
Have you ever studied in the UK?
Yes
No
If yes, please provide full details of study durations. Please also include a copy of your previous
visa (must be completed for visa purposes).
From
//
to
//(dd/mm/yy)
Have you ever been refused a visa for the UK?
Yes
No
Have you ever been refused a visa application to any country?
Yes
No
If yes, please provide full details
INTO London 20162017
Application form 2 of 2
Section 5
Current English language proficiency
Please tick and enter details of your most recent English language test.
Have you arranged to take any other English language
test(s) before starting your INTO course?
Note: students will be assessed upon arrival and study plans WILL be altered if there is any discrepancy. Please
Yes
No
provide a copy of your certificate.
Name of exam
IELTS for UKVI
Trinity College London
Other (please specify)
Date due to be taken
//(dd/mm/yy)
Section 6 Welfare
Do you have any conditions, medical or otherwise, that may impact your time in the UK?
Travel and medical insurance
The full cost of Uniplan Insurance will be added to the invoice unless proof of alternative adequate
cover is included with the application.
Yes
No
Completion and signing of this form gives INTO permission to administer first aid by trained staff first aiders if required.
Do you consider yourself to have a disability?
Yes
No
Have you been convicted of a relevant criminal offence?
Yes
No
If you have answered yes to any of the above, please provide full details with your application
on a separate sheet.
Please specify what insurance package you would like.
Standard
Premium
Uniplan Insurance cover commences one week before your programme start date and finishes one
week after your programme end date. If you require a longer period of cover please complete the
start and end dates below:
Start date
//(dd/mm/yy)
End date
//(dd/mm/yy)
I have my own insurance and enclose a copy
Section 7
Accommodation options
Please note that INTO aims to provide the highest preference requested but, if this is not
available, INTO reserves the right to provide or suggest alternative accommodation.
Confirming your accommodation early gives you the best chance of getting the building and
room type you want.
Please indicate the building and room type you would prefer by ticking 3 boxes opposite to
indicate your 1st, 2nd and 3rd choice of accommodation.
Do you require homestay during the holiday periods?
Yes
No
Do you envisage that you will have any specific requirements in student
accommodation as a result of a disability/medical condition?
Yes
No
Dietary requirements
Please give details of special dietary requirements e.g. halal, vegetarian, no pork, any food allergies.
Section 8
2nd preference:
3rd preference:
Scape East Studio
Scape East Studio+
Scape East Studio++
The Craft Building Classic en suite
The Craft Building Premium en suite
The Craft Building Premium Studio
Homestay
Meal plan
Do you require a meal plan? (available at Scape East only)
Yes
No
Airport pickup
Flight details including arrival date and flight number should be emailed to ukarrival.details@into.uk.com
as soon as possible. All under 18 students must either book an INTO airport pickup or provide evidence
of alternative arrangements.
Section 9
1st preference:
Do you require an airport pickup?
London Heathrow (130)
London Gatwick (150)
London Stansted (160)
Declaration
I am aware that I qualify for study at an INTO University Partner Centre and that INTO
recommends study at an INTO University Partner Centre because it offers guaranteed
progression to a specific university partner and degree programme. I have chosen to proceed
with applying to INTO London and I confirm I am not interested in studying at an INTO
University Partner Centre.
Student records
I agree that copies of my academic progress and performance reports can be
supplied to parents, sponsors or education counsellors without further notification
Yes
No
Yes
No
I agree that my records and achievements may be used
for promotional purposes, without further notification
I declare that the information I have supplied on and with this form is complete and correct
I have read and understood and agree to abide by the Terms and Conditions available at:
www.intohigher.com/into-london/terms
I agree to abide by the Cancellation and Refund Policy
I agree to pay all tuition and accommodation and sundry expense fees as they become due
I understand that the giving of false or incomplete information may lead to the refusal
of my application or cancellation of my enrolment
Signed
Date
(dd/mm/yy)
(Parent/guardian) For students under 18
Or
Signed
Date
(dd/mm/yy)
(Student)
INTO Giving Support our charity
INTO Giving helps transform lives by supporting educational projects around the world. We work with projects that provide access to good quality education for young people living in difficult circumstances.
Before you arrive at the centre, you can donate 25 to help provide an education for one of the 57 million out-of-school children by ticking the box below.
To find out more about INTO Giving, visit our website www.into-giving.com
I confirm that I would like to make a donation of 25 to INTO Giving and agree for this donation to be added to my invoice/financial statement.
I am happy to receive INTO Giving newsletters and project updates via email.
