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KEELE UNIVERSITY PROCEDURES

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BUSINESS PROCESS: Enrolment of Students

PURPOSE: This process deals with the enrolment of students to Keele

SCOPE: Covers students enrolling on a new course at Keele – students re-enrolling follow a separate, documented, process.

PROCESS OWNER: Academic Registrar

INVOLVED: SCI & Exams Postgraduate Office Graduate School Continuing Education Unit



PROCEDURE / WORK INSTRUCTIONS: Undergraduate and postgraduate applicants to Keele apply electronically, undergraduate through UCAS and Postgraduate through the electronic application form – both of which generate Application Clearance & Decision Entry (ACD) records. For the Keele on-line application form a TRAN process is performed daily to convert on-line applications into ACD records. The ACD records are maintained by the relating office i.e. UG by the UG Admissions Office; Postgraduate Taught (PGT) by the PG Office and Postgraduate Research by the Graduate School. Once a student has accepted a place at Keele, after meeting conditions of offer which have been made, then the ACD record decision/response field is changed to UF completed by the responsible office. This identifies the correct files to be processed through ATR. Details of the ATR process for UG, PGT and PGR students is attached in Annex A of this business process. Responsibility for carrying out the ATR process is as follows:

• Undergraduate students – SCI

• PGT students – PG Office

• PGR students – Graduate School For Undergraduate records to process through ATR the Admissions Office communicates that the global update has been processed to SCI so that they can commence the ATR process. The ATR process generates a number of student records for the student, including the SCJ, SCE and SPR. The SCE record has an enrolment status of Provisional (P): POSTGRADUATE TAUGHT STUDENTS ATR PROCESS At the point when the applicant has an ACD record decision/response field of UF then the Head of the Postgraduate Office begins to ATR all UF applicants (please refer to ATR process stated above), this process begins from June onwards before the start of the new academic year. Some overseas students will not be processed through ATR until a deposit has been received (this is flagged through the UDF deposit field). Once the student has been through ATR then an enrolment record is printed from the SCE (please see notes above). The enrolment form is checked and signed by the student during induction week at a scheduled appointment. Any amendments are then processed through the QSU screen (please see notes above) and the SCE status changed from P to C. CONTINUING EDUCATION (CE)STUDENTS: CE students do not have electronic application processes and ACD records are not created for CE students, so no ATR process is carried out for these students.



1. ENROLMENT PROCESS UG & PG

For a student who needs to be enrolled an enrolment form now needs to be printed off. To print off enrolment forms, enter the student number into the SCJ code field and press retrieve (F5). From SCE select Current from the top tool bar, Generate and print letters. To note: A batch of records can be retrieved and enrolment forms printed by entering broader criteria, i.e. course code, mode of attendance, block (level of programme/cohort) or entering a Batch code and pressing F5 to retrieve so that these batches can be printed off as one.



Then the appropriate letter code needs to be entered for the newly enrolling student. For example, for an Undergraduate enrolling the letter code of UGENROL is to be used followed by the enrolment year, i.e. 09 for 2009. For PGT students PGTENROL is to be used followed by the enrolment year, etc. Example copies of these enrolment forms are attached in Annex B of this business process. The enrolment form is then printed off.



Enrolment forms are distributed to students at face to face enrolment events during the first few days of arrival. Students then have the opportunity to check, amend the content as needed and then sign their forms. These forms then have to be handed in for the student to be allocated a Keele Card and other essential student information. The enrolment form is then processed through QSU (Quick Enrolled Student Update (QSU), the QSU screen is as follows:



To update the student record and complete the enrolment process, in the SCJ Code field – enter in the student number from the enrolment form– for UG students the 2nd bar code on the back of the enrolment form can be scanned with the scanner provided. Retrieve the student (F5) – if the scanner has been used this does not need to be done. This should only bring up 1 of 1 SCE record – refer to the top of the screen for this information. You will then need to change the following information: SCE STATUS – P (provisional) to C (current) or (for UG students) scan the 3rd bar code on the back of the enrolment form with the scanner provided. Then click update & store (F6 or click on file then store) (You don’t need to do this if you have used the scanner provided). Please note that from this screen you can amend information from the enrolment form reflecting student amends or additional information that has been gathered. Fields that are of particular interest are: Qualifications on Entry; Parental Education History; Term-Time Accommodation; Ethnicity; Domicile; Nationality; etc. These fields can all be updated by clicking on the icons on the right side of the QSU screen; the Report Fields button is particularly useful. Always ensure after any amendment in these additional screens you store before closing the screen.



2. ENROLMENT PROCESS CONTINUING EDUCATION (CE) A prospective student will complete the application form (annexed to this process – Annex C) in hard copy and this will be returned to the CE Unit. The application form is checked to ensure that there is adequate information returned, the applicant is suitable for the course and that the correct fee has been received. Administrative staff within the CE office then uses the QSS (Quick Student Setup) screen to set up the student record. Quick Student Set-Up Screen (QSS) • From Main Menu, type ‘QSS’ + Enter or if you are already in the screen, press F12 to

clear the screen. The screen should look like this:



Quick Student Set-up (QSS) • Ensure that the boxes next to the following headings (top left hand corner of the

screen) are ticked:

• Enter year e.g. 03/04

• Enter start and end date

• Enter Course e.g. CPEUGCB

• Enter Block (e.g. 1A) & Occ (08)

• Enter Mode of Attendance of MOD

• Enter Programme (CPEUGBC) and ROUTE (OPNUGCB)

• Enter level 1 (credit bearing ) and 0 if it is non credit bearing

• Enter : Surname; Forename; Title; Gender; Birth date

• Enter Fee Status: UK (standard fees); UKP (pensioned fees); UKB (benefited fees) • Now hit the generate button in the bottom right hand corner of the screen. You will

enter a screen that looks like this:

• Check the list to ensure that the student does not already have an existing record (from

a previous course) and SRS number. If they do, select the relevant record and click OK. Alternatively, if the student’s details do not match any that appear, click NEW.

You will now return to the main QSS screen. If you have generated a new record, a message will appear in the status bar at the bottom of the screen and an SRS number will appear in the relevant box. If the student has formerly studied at Keele their original SRS number will appear in the relevant field.



For new students from the QSS menu select ‘other’ (from top tool bar) and then ‘student details’ and input data from the application form. Ensure that you store the record and make a note of the student number on the application form for a record. This process has generated a Current student record. Return to the main menu. The User Defined Enrolment (UDE) screen is accessed from the main menu, by entering UDE. At the bottom of the screen click on PROFILE pick list and select 1 (KU MODULE) then enter the SCJ number on the SCJ field and retrieve the record (F5). Ensure you find the correct record by checking the year and course details. Once you have found the correct record then retrieve (F5), check details such as fee status, then click on Save. The system then takes you to the SMO screen – where you need to input the module code that they are to study; the occurrence of the module i.e. A, B or C; the year of study (current academic year); Period – semester details; then save the record and the student details should be populated to the SMO record which has been created. Close the open screen and the system will automatically process to the FDU screen. The system then takes you to the FDU record to ensure that the correct details are populated – this record is generated automatically during the QSS process. Close the FDU screen to automatically enter the CLEH screen. In the CLEH screen the administrator enters how the student is paying in the documents field by selecting the correct document method (payment type) from the drop down menu. As you tab out of this field you will see that some fields are automatically populated. Then enter the SCJ number into the student code field and tab out and the screen is populated; then enter the fee amount which should correspond with the fees due field on the FDU record – the amount is entered as a negative number i.e. -55.00; The external reference has to be entered which is the module code with the occurrence added to the end of the module code – save this record and close the screen and the UDE record. To print the enrolment form for the student (or for a batch of students on a module) select SMO from the main menu – enter the SCJ number, select the correct module for the student and retrieve. Click on Current in the top tool bar and select generate & print letter – enter the following letter code CPENROL2 and click generate and then print. Enrolment forms are then printed. It is efficient to print enrolment forms by modules to print off all the students studying a module in one step, by entering the module code and pressing retrieve to retrieve all students on the module. . Enrolment forms are then placed in the relevant tutor pack, the tutor is responsible for getting the students to sign the forms – which are then returned to the CE office - which are then checked for any data amendments, and action any changes on the system. The enrolment form is then filed.



NURSING & MIDWIFERY STUDENTS: The same process is followed for Pre-Reg students as stated for UG records above; however, the student enrols on-line – not through signing and returning a hard copy enrolment form. The School provides Management Information Services with the Course Codes and Route Codes for the courses for which they wish students to enrol electronically – this is done after the ATR process – so that the prompt to enrol is generated systematically. On ‘Process Day’ students visit the School and complete an enrolment form on-line using e-vision. The students are provided with their E-Vision log on details on Process Day (enrolment event) and log on to complete the enrolment process. Once this is completed they are emailed to confirm that they have successfully enrolled and that they print this confirmation off to present to School staff to receive their Keele Card and other essential student information. This process automatically updates the students SCE record from P (provisional) to C (current) and updates relevant student data fields. Students wishing to enrol on a Learning Beyond Registration (LBR) degree complete the form attached in Annex D of this process. The form is received by the School and once an admissions Tutor has decided that the candidate can be accepted onto the course the details from the form are used manually to create an ACD record through the Quick Applicant Setup (QAS) screen. The School then emails SCI with student names, numbers and course details requesting that the ATR process is run for these students. When the School has received an ATR batch code, to confirm that the process has been completed, the School administrator then generates and prints off the enrolment form (through the SCE – as detailed above), and other registration forms. The enrolment form is checked and signed by the student – and then returned to the School who then forwards it to SCI so that the status on the SCE can be changed from P to C, in the QSU screen (as detailed above).



SUPPORTING BUSINESS PROCESS FORMS:

Annex A – UG, PGT & PGR ATR Processes Annex B – UG & PG Enrolment forms Annex C – CE Application Form Annex D – Nursing & Midwifery LBR application Form

TIMESCALE OF PROCESS:

EXISTING QUALITY CONTROLS / AUDIT CHECKS:

System password protected and access restricted.

DATE PROCESS APPROVED: February 2010

DATE PROCESS TO BE REVIEWED:

February 2011



ANNEX A – UG ATRING STUDENTS

UG - ATRing students Type ATR into main menu You need to input:

• Academic year (year of entry)

• Status – A (applicant)

• MAS course – ·|UMBCSH

• SRS course – UG*

• Block – either 0, 1 or 2 or 3 (or combination of these) – this will NOT retrieve nurses/midwives etc.

• Occ - 09

• Dec/rp - *UF (i.e. either CFUF or UF)

• IMPORTANT – Then click ‘more details’ and type ‘A*’ (AS12 form returned) in the field ‘N-ac con met’ (this confirms that they are ready to ATR)

• Click ‘Apply’

• Then F5, retrieve

• Check that all block 0 students are on an ‘FY’ CRS

• Check that no block 1, 2 or 3 students are on a ‘FY’ CRS

• Ensure the batch code you wish to use is written onto both the SCE and SPR Batch Code fields

• In the ‘Report mode’ section of the screen (bottom right) select ‘Detail’ and ‘MAS course’

• You can leave the rest of the fields as they are, blank or otherwise

• Click ‘Run now’ Check message buffer for any errors and in particular students not ATRd. This could be down to CBO not existing. Save the message buffer on P drive (under SCI, ATR) Also check that diets have run (are all MAVs created?), start dates are on SCE (they should do, provided CBOs have start dates!) –



After students have been ATRd, you should check the following on SCE (retrieve them by using ‘batch’):

• Start date is correct for all students. If SCE is wrong, you will need to change this and also change SCJ and SPR. For block 2 or 3 students this definitely will be incorrect since start date will show 1 August – this needs to be changed!

IT-ACCOUNT information cannot be printed until the process has run at either 13.30 or 19.30 RUN THE PROCESSES TO RUN ADD THE ELE/ELT FLAG AND FEE PROFILE IN ORACLE (if you leave over night this process runs automatically) FINALLY IN SCE RETRIEVE ONLY THE ELT STUDENTS, ALL, GEN + PRINT, NDS:ELT_MOD – check SDL for the ENL module with Action = temporary add If you have ATRd a large batch (over 100 students), you may wish to separate these into batches using 14/JUL/2008A, 14/JUL/2008B, etc. to differentiate– Keeley – use your judgment on this:

• To sort out batches, retrieve ALL students just ATRd and then drop all but the first 100 records and globally update the batch to 14/JUL/2008A. Then do the same again and globally update the next batch to 14/JUL/2008B etc.

Checking Elective credits (this also shows you the number of core modules added to each student)

• Type ELR / ELRR in the main SCIMS menu

• Select ‘EL Reports’

• Select ‘EL10: Electives Validation Report’

• Put the SCE Batch Code in the SPR Batch field. This must be in the format 14/JUL/2008A otherwise you won’t retrieve anything.

• Academic year ie 2009/0

• Leave other fields at ‘ANY’ or ‘ALL’

• In the ELE/ELT field, first select ‘<Blank> Home’

• Sort by route

• Then click ‘view/print’ report

• Then print this out on normal paper



• This will give you a list of ALL non-ELE/ELT students just ATRd

• Then repeat this but, put ‘EL Exempt or Test’ in the ELE/ELT field to give you all the ELE/ELT students just ATRd

This needs to be checked to ensure that the student will be asked to select the correct number of Elective modules, based upon their route Note that:

• If in block 0 (FY student), number of Elective modules should be 0

• Likewise if studying Medicine, Physio, Social Work, Pharmacy

• If student is ELT and is studying a course requiring Electives, the number of Electives required should be shown on the report

When all above has been done, you are ready to print the documentation. So that the person printing the documents has a list of which ATRd students are Home and which are ELE/ELT, you can give them the EL10 report that has just been printed, which lists them on separate reports. The following documentation needs to be produced for the Fresher’s Pack:

• ELO1 Module form – this will either be the form itself, or a single sheet of A4 stating that particular student does not require Elective information (for example, FY, ELT, Medical students etc.)

• Welcome letter

• Photograph and signature form

• Home students - need one set of address labels Overseas students - need two sets of address labels

• Direct Debit form

• Remittance form for cheque payments

• Proforma invoice for tuition fees (only students with a fees status of ‘OS*’ on their SCE record have this Proforma)

• IT Account Information



You will be printing items in two batches:

• Home students – these students can be identified by having a blank ‘ELU test’ field under the UDF button on their SCE record

• International students - these students can be identified by having either ‘ELT’ or ‘ELE’ in the ‘ELU test’ field under the UDF button on their SCE record

ELO1 Module form Retrieving the forms

• Type ELR in the SCIMS main menu

• Choose ‘EL Student Forms/Letters’

• Then choose report ELO1: Principal Subject & Module Confirmation Form

• Leave Student SPR code blank

• Put the SCE Batch field in the SPR Batch field. This must be in the format 14/JUL/2008 otherwise you won’t retrieve anything. You will need to add a letter (e.g. ‘A’) to this date if an ATR for a particular day has been split into batches.

• Select correct academic year

• SCE Sequence – ANY

• SPR Level – 1

• Leave the next 3 fields as their default values

• Select ‘<Blank> Home’ in the ELE/ELT field

• Ensure ‘Alpha Filter Batch’ shows ‘All’

• Click ‘View/Print’ report

• The forms should then be displayed Printing the forms

• Select ‘print’ on the menu bar

• When the print dialog box pops up, go to ‘Properties’. Choose: o Document Style – 2-sided (Book) o Normal A4 paper tray

• Then OK twice

• The ELO1 forms will go onto two sheets so need to be stapled together (unless no Electives required, in which case this message will print on a single sheet)

• Then select ‘close’ to return to the report menu



When you’ve carried out this for the home students, do the same for the ELE/ELT students. To do this follow the above instructions, but rather than selecting ‘<Blank> Home’ in the ELE/ELT field, select ‘EL Exempt or Test’. Keep the batches of Home and ELE/ELT separate Other documentation Retrieving the records for Home students

• Type ‘SCE’ in the SCIMS main menu

• In the SCE batch field type the date the students were ATRd in the format 14/JUL/2008A

• IMPORTANT - Then click the ‘UDF’ button (top right of the SCE record) and type ‘+=’ (the + character must be the one from the far right of the keyboard) into the field ‘ELU Test’ and click ‘Apply’. This means you are retrieving records with a blank in this field, i.e. Home students, not ELE or ELT.

• The F5, retrieve. Printing the various documents for Home students Welcome letter

• Go to ‘all’ on the menu bar and then ‘Generate and print letters’

• Type in ‘UGWELCLET09N’ in the letter code field

• Click print (it will now take some time to process these)

• When the print dialog box pops up, go to ‘Preferences’. Choose: o Document Style – 2-sided (Book) o Tray 4 (Letter headed – check that this is in tray 4 and that it is FACE

DOWN) o OK

• Then print

• You will be returned to the retrieved SCE records



Photograph and Signature form • Go to ‘all’ on the menu bar and then ‘Generate and print letters’

• Type in ‘PHOTOFORM’ in the letter code field


• When the print dialog box pops up, go to ‘Preferences’. Choose: o 1-sided o Select the bypass tray (check that the photo form paper is in the bypass tray

and that it is FACE DOWN with the plastic sleeve at the top right) o OK

• Then ‘print’

• When the bypass tray runs out of paper a message will appear on the display screen on the printer, you will need to keep adding paper to the tray (wait until the tray is empty before adding more paper otherwise this could cause the printer to jam).

• You will be returned to the retrieved SCE records Labels


• Type in ‘ADDRLABEL’ in the letter code field


• When the print dialog box pops up, go to ‘Preferences’. Choose: o 1-sided o Select the bypass tray (check that labels are in tray 4 and that they are

FACE DOWN) o OK o Number of copies ‘1’


• When the bypass tray runs out of paper a message will appear on the display screen on the printer, you will need to keep adding paper to the tray (wait until the tray is empty before adding more paper otherwise this could cause the printer to jam).

• You will be returned to the retrieved SCE records



Direct debit mandates

• Before printing the direct debit mandate forms check the following in your web browser: go to file and then select page setup. Check the Header / Footer fields, both these fields should be blank, if there is any text in either of these fields, delete it. Then check that all the margins are showing as 12.7mm, if anything different is showing change the appropriate fields to 12.7mm. Then select OK.

• You can now print the letters, however they will need to be done in batches of 20 (see below)

• With the students records retrieved, sort them into alphabetical order by sitting in the name field on the first students SCE record and going to ‘misc, then ‘sort’ (leave the defaults set as they are e.g. sort by ascending), click OK, this will sort the records into alphabetical order

• * Go to ‘all’ on the menu bar and then ‘Generate and print letters’

• Type in ‘DDFORM’ in the letter code field

• In the record / range field enter batches of 20 as follows e.g. 1 to 20, then 21 to 40 etc

• Click ‘print’ this will generate the forms (it may now take some time to generate these)

• When all the forms are generated they will appear on the screen in your web browser (the web browser only has so much memory, so if all the forms for your batch do not print it is because the web browser memory is full. You will therefore need to make the batches smaller, however, batches up to 20 should be OK)

• Go to ‘file’ then select ‘print’

• When the print dialog box pops up, go to ‘Preferences’. Choose: o 2-sided o Select tray 1 (plain A4 paper) o OK o Number of copies ‘1’


• When you have printed each batch you will then need to repeat the above points from * to print the following batches of 20

The reason for printing in batches is that the (Sharp AR-M451N PS) printer does not have enough memory to print large quantities, you can however send the print job through to the main Copier (Sharp AR-M700N PS) this printer/copier has a larger memory so can print larger batches.



Remittance Advice Slip

• Before printing the remittance advice slips check the following in your web browser: go to file and then select page setup. Check the Header / Footer fields, both these fields should be blank, if there is any text in either of these fields, delete it. Then check that all the margins are showing as 12.7mm, if anything different is showing change the appropriate fields to 12.7mm. Then select OK.

• You can now print the forms, however they will probably need to be done in batches of 20 (see below)

• With the students records retrieved, sort them into alphabetical order by sitting in the name field on the first students SCE record and going to ‘misc, then ‘sort’ (leave the defaults set as they are e.g. sort by ascending), click OK, this will sort the records into alphabetical order

• * Go to ‘all’ on the menu bar and then ‘Generate and print letters’

• Type in ‘REMADVICE’ in the letter code field

• In the record / range field enter batches of 20 as follows e.g. 1 to 20, then 21 to 40 etc

• Click ‘run’ this will generate the forms (it may now take some time to generate these)

• When all the forms are generated they will appear on the screen in your web browser (the web browser only has so much memory, so if all the forms for your batch do not print it is because the web browser memory is full. You will therefore need to make the batches smaller, however, batches up to 20 should be OK)

• Go to ‘file’ then select ‘print’

• When the print dialog box pops up, go to ‘Preferences’. Choose: o 1-sided o Select tray 1 (plain A4 paper) o OK o Number of copies ‘1’

• Then ‘print’ When you have printed each batch you will then need to repeat the above points from * to print the following batches of 20 IT Account Information


• Type in ‘IT-ACCOUNT’ in the letter code field




• When the print dialog box pops up, go to ‘Preferences’. Choose: o 1-sided o Select tray 1 (plain A4 paper) o OK


• You will be returned to the retrieved SCE records Retrieving the records for ELE/ELT students Clear the SCE screen (F12) Follow the instructions as for home students except:

• After clicking the ‘UDF’ button on the SCE screen, type the ‘*’ key (on the far right of the keyboard) and then ‘Apply’. This means you are retrieving records with anything (either ELE or ELT) in this field.

Printing the various documents for ELE/ELT students Follow the instructions as for home students but also print the proforma invoice for OS students and print 2 sets of labels rather than just 1 set Proforma invoice for tuition fees


• Type in ‘UTF-PROFORMA’ in the letter code field


• When the print dialog box pops up, go to ‘Preferences’. Choose: o 1-sided o Select ‘paper’ from menu bar – select ‘paper type’ and choose ‘letter head’ o Select tray 4 (check that letter headed paper is in tray 4 and that it is FACE

UP) o OK


• You will be returned to the retrieved SCE records Note – you may not have one of these proformas for all ELE/ELT students since it is only relevant to those with an OS fees status on their SCE – just make sure one has printed for



all OS students Distribution Home documentation to Janice ELE/ELT to documentation to Gill or Sue Would Medicine documentation to Medical School – Julia Molyneux Printing the various documents for Nursing and Midwifery students Nursing and Midwifery students do not require any documents printing Printing the various documents for Osteopathy students Janice to advise which documents these students require



ANNEX A - Postgraduate ATR

B5 Transferring a student from MAS to SRS when offer confirmed (applicant transfer)

These processes may be carried out by system supervisors only. 1 Applicant transfer To be completed once an applicant is UF – transfers them to the SRS system, and

creates a number of SRS records. ATR



2 PGT students • First on DS1 and DS2 retrieve all UF overseas students with A status, and

print out their visa letters (PGTV)

• Retrieve a batch of students ready for transfer by defining the following: o Year of entry o Month of entry o A in status o PGT* in SRS course o *UF in dec/rp field

• Ensure that the following records to be generated have been ticked (all SCEs should NOT be ticked):

o SCJ o SCE o SPR o SPI o (not Student diet yet)

• Check Student Status defaults o APF status: A o CAP status: AT o STU applicant status: A o STU student status: C

• Check Student Course Status defaults o Student Course Join: C o SCE status: P o Future SCE status: P

• Check SPR defaults o SPR status: C o SPR batch: blank o Source of intended award: VAR

• Check SCE defaults o SCE batch: <<&$date>>

• Report mode: o Summary (default)



• Department o MAS (default) - MUST BE SET TO MAS FOR DEPARTMENT TO

TRANSFER

• When all is OK, Run Transfer

• Check messages to make sure transfers are all successful (message buffer)



Annex B



Annex C



idwifery

School of Nursing & MAPPLICATION FORM

Please complete this form legibly in black ink and return it to Customer Services at the address below:

Course applied for: Commencement date:

Personal details Surname: First name(s): Title: Previous Surname: DOB: Age: Marital Status: Home address: Work address: Home telephone: Work telephone (inc. extension): Mobile Telephone: Work fax: Home email: Work email: Next of Kin: Surname: First Name (s) Title:

Annex D



Home Address: Contact telephone:

Office use only: Date application received: Date acknowledgement sent: Keele No.

School of Nursing & Midwifery, Keele University,

Clinical Education Centre, University Hospital of North Staffordshire NHS Trust, City General Hospital , Newcastle Rd, Stoke on Trent ST4 6QG.

Tel: (01782) 556600: Fax (01782) 556576: E.mail: [email protected]

mailto:[email protected]



General educational qualifications

Type of exam (eg GCSE , AS, A2)

Subject Year completed

Grade

Professional qualifications / study (include any courses you started but did not complete)

Qualification Educational establishment Date

Annex D



Higher educational qualifications (include any courses you started but did not complete)

Qualification (eg diploma, degree) (include

grade / class)

Educational establishment Dates From To

Name & address of present employer Position held: Hours per week: NMC PIN: Expiry date:

Annex D



Employment history (most recent first & stating part-time or full time)

Employer’s Name & Address Position held From To Reason for leaving



References Please give the names and addresses of two referees including contact telephone numbers and email addresses. The referees should be your current employer and, if possible, from your professional education establishment. Alternatively, your second referee may be from a recent professional / higher education course. Are you happy for referees to be contacted or would you like to be contacted first? (Please tick appropriate box) □ I am happy for referees to be contacted. □ I would like to be contacted first.

1st Referee (Professional) Name Address Contact telephone Email address In what capacity do you know your referee?

2nd Referee (Academic) Name Address Contact telephone Email address In what capacity do you know your referee?

Annex D



Additional supporting information This space is provided for you to include supporting information. This may include reasons for undertaking your chosen course. Please add an additional sheet if required.

Annex D



Rehabilitation of Offenders Act 1974 (Exception Order 1975) Because the course for which you are applying involves direct contact with people who are receiving a health service, we are obliged to ask you in connection with this application to disclose any convictions you may have. Under conditions of the above Order, you are not entitled to withhold information about convictions, which otherwise might be considered spent. In the event of employment, failure to disclose such convictions could result in dismissal. Have you ever been convicted of a criminal offence, bound over or cautioned? Yes / No If Yes, we may approach you for details of the offence prior to interview. All information will be treated as strictly confidential.

Declaration I declare that the information provided on this form is accurate and complete. I understand that any wilful statement or omissions render me liable to disqualification. Signature: Date:

Quality assurance As part of our continuing desire to improve the quality of our services, please indicate below how you heard about this course.

Annex D



Keele University

School of Nursing & Midwifery Equal Opportunities Monitoring

The following information is needed for your application. Please tick the relevant boxes and return with your completed application form. Ethnic origin (please tick one box)

White Indian Chinese

Caribbean Pakistani Other

Black African Bangladeshi Asian other

Black other Information refused

Country of Birth

Country of Domicile

Disability (please tick one box)

My disability

is NOT

Information refused

I have a registered Disability

registered

I have no disability

I am in receipt of disability allowance.

I am not in receipt of disability allowance

Annex D


Annex D


Type of disability and / or any other medical condition (please tick)

Dyslexia Asthma

Deaf / hearing impairment A disability not listed here

Blind / partially sighted Diabetes

Personal care support Epilepsy

Mental health Wheelchair users / mobility difficulty

Multiple disability

Thank you


Annex D


KEELE UNIVERSITY SCHOOL OF NURSING AND MIDWIFERY

Name & Address: ……………………………………………………………………………………….. ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… Place of Work: ……………………………………………………………………………………………. ……………………………………………………………………………………………………………… Course Applied For: …………………………………………………………………………………… ……………………………………………………………………………………………………………… Funding Details: Who will be funding the Course? Self (100%) or Employer*



Please Note: If payment is to be deducted from salary, it is the responsibility of the student to inform the relevant Salaries Dept. THIS FORM, TOGETHER WITH THE EMPLOYER FUNDING FORM MUST BE RETURNED WITH YOUR APPLICATION FORM. IF YOU ARE FUNDED BY YOUR EMPLOYER, FAILURE TO RETURN A COMPLETED FUNDING FORM, OR SUPPORTING LETTER WITH THIS APPLICATION, WILL RESULT IN YOUR APPLICATION NOT BEING PROCESSED.

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