SupplementaryInformationSheet–M2A.docVIP

Supplementary Information Sheet – M2A In addition to the M2A Participation Form, please complete the following – Name: Date of Birth: Nationality/Citizenship: Name of Course Applied For: Criminal Convictions – Do you have a relevant criminal conviction? Please check the relevant box. Please see relevant section of the ‘Guidance Notes’ below. YES NO Disability - The University encourages you to disclose your disability, medical condition, wellbeing difficulty or specific learning difficulty to ensure that we can advise you on the range of services and adjustments we can provide. Please check the following box es as appropriate: Please see relevant section of the ‘Guidance Notes’ below. A – No Known Disability B – Autism/Asperger’s C – Blind/Visually impaired/Deaf D – Hearing impaired/Deaf E – Unseen disability diabetes, epilepsy, heart condition, Cancer etc. F – Wellbeing difficulties including anxiety, depression and phobias G – Dyslexia H – Wheelchair user/mobility difficulties I – Other disability J – Multiple disabilities/complex ______________________________________________________________________ Residence - If you are an EU national including the UK but have lived outside the European Economic Area EEA for any periods over the last three years other than holidays , please list your periods of residence outside the EEA and the purpose of your stay e.g. work, education, etc. You may be required to provide evidence. Please see relevant section of the ‘Guidance Notes’ below. Have you been a resident other than holidays in the EU for the three years prior to the start of your postgraduate study? Please check the relevant box. Yes - No - If NO, please complete the following information, duplicate if needed on separate page: Country: Start Date: End Date: Purpose: Country: Start Date: End Date: Purpose ___________________________________________________________________________ DECLARATION I confirm that the information provided on th