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Research area of interest * Year *

Title (Dr, Mr, Mrs, Ms, etc) * First/given name * Family name/surname * Date of birth * Country of birth * Nationality * Passport No * Domicile (Country of permanent residence) *

Date of arrival in Geneva (CH) Passport expiry date

Home address

Address line 1 * Address line 2 Postcode * Country * Home telephone number Mobile * Personal email *

Current address (if different from home address)

Address line 1 Address line 2 Postcode Country Telephone Email

If no, have you taken your IELTS examination

Please give details of your main qualifications to be considered for entry (BSc, BA, MSc, etc.). List in reverse chronological order giving most recent first.

Please give details of any professional qualifications held and specify whether obtained by examination, exemption from examination, or by other means. List in reverse chronological order giving most recent first.

(If appropriate attach confirmation to your application)

Contact name Company / Organisation Address line 1 Address line 2 Postcode Country Telephone Email

Please give details below of employment including previous positions held with present employer. List in reverse chronological order giving most recent first. (Note: please send as an e-mail attachment (dba@iig.ch) a CV/résumé in addition to this information)

Please give details of two referees below. We might contact them for further information about you.

First referee

Name * Position * Company / Organisation Address line 1 Address line 2 Postcode Country Telephone Email

Second referee

Name * Position * Company / Organisation Address line 1 Address line 2 Postcode Country Telephone Email

We would like to interview applicants before recommending admission. Kindly give a contact number which can be used for this purpose.

Contact number

Relevant criminal offences include convictions, cautions, admonitions, reprimands, final warnings, bind over orders or similar involving one or more of those listed below:

Any kind of violence including (but not limited to) threatening behaviour, offences concerning the intention to harm or offences which resulted in actual bodily harm

Offences listed in the Sex Offences Act 2003

The unlawful supply of controlled drugs or substances where the conviction concerns commercial drug dealing or trafficking

Offences involving firearms

Offences involving arson

Offences listed in the Terrorism Act 2006

If your conviction involved an offence similar to those set out above, but was made by a court outside of Great Britain, and that conviction would not be considered as spent under the Rehabilitation of Act 1974, you should tick the box above.

I confirm that, to the best of my knowledge, the information given in this form is correct and complete. I understand that the decision to offer me a place rests solely with the University of Plymouth and is not subject to appeal. I understand that if I am offered a place on the program, I agree to abide by the rules and regulations of the University of Plymouth.

Date

Please ensure you scan and send us by e-mail (dba@iig.ch) the following items with this application form (incomplete applications will not be processed)

Documents to check