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– Please ensure you are logged into the Intranet to ensure that the auto-populate inserts your name and department.
The deadline for applications is Friday 20th April 2018.
*This is information required by Student Records
Title – Please add the title you normally use
Informal Name – This is any name that you wish to be known by
Date of Birth*
Qualification to which you are applying
Communication with you
Permanent Home Address
Your Permanent home address. This address will also be used as the address for correspondence
you give details in the ‘Correspondence’ section
Permanent Home Address line 1
Permanent Home Address line 2
Town or city
If you are a resident away from home, eg as a student, or you may be away from home for a significant period, please give your contact address and dates. This is the address to which we will send official correspondence relating to your application
Correspondence address line 1
Correspondence address line 2
Town or City
*your phone number is only for contact if there is an issue with your email or postal address. It will not be disclosed to a third party.
Home Phone Number
Are you currently studying towards any other courses or qualifications?
If yes, please give details and the expected end date.
Current Studies – max. 500 char
Nature of work and position held
Note: all applicants must complete this section.
Please use this space to briefly answer the following questions:
. What is your interest in technology enhanced learning?*
. How will the course fit with your current role?
. What initial ideas do you have for a project? (The course is focused around supporting you whilst carrying out a
. How will you ensure that you have sufficient time to complete the course?
Max. 500 words
Equal Opportunities Monitoring
The University welcomes applications from people with specific needs and considers them on the same academic grounds as those from other candidates. It is helpful to know about your specific needs in advance so that we can discuss any appropriate reasonable adjustment with you. Applicants with specific needs are encouraged to contact the disability co-ordinator, tel:024 7657 3734 or email:
Do you consider yourself to have a disability?
Specific Learning Difficulty
Mental Health Condition
Other conditions not listed
If your condition(s) is/are not listed and you would like to tell us about it/them please do so here
Are you a registered disabled person?
I hereby apply for admission to postgraduate studies at the University of Warwick and I confirm that the information provided above is correct to the best of my knowledge. I understand that any offer of admission may be withdrawn if I cannot provide documentary evidence of any statements on this form.
Support from line manager/ supervisor to enrol on the course
Your line manager or supervisor should approve of your participation on the course.
Name of line manager/ supervisor
indicates a required field
The data on this form will be used as part of the PGA Technology Enhanced Learning application process. This data will not be used of any other purpose. If you have any specific questions please contact firstname.lastname@example.org