APPLICATION FORM

Full Time Courses 2012

Please complete each section fully and write in Block Capitals. You must return this application with copies
of your qualifications as listed. If you have any questions, please contact your Admissions Advisor.

Section 1 - Personal Details

Title: Surname:

First Name:

Date of Birth: Gender:

(please circle) MALE / FEMALE

Address:

Postcode: Country:

Home Telephone:

Mobile Phone:

Email Address:

Myspace/Website:

Section 2- Residency Declaration

Please tick [√] the appropriate box.
Nationality:

Please select:
UK EU Other

Do you require a visa to

study in the UK? Yes No

Have you resided outside the

UK/EU in the last three Yes No
years?
If yes, please state the date
of your most recent _______ / _______ / ___________
residency in the UK/EU: DD MM YYYY

Which of the following (if UK/EU Current Other

any) do you currently hold: Passport Student Visa Eg. Right to
remain, etc.
If other, please specify:

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Section 3 – Education

Name of your current or most

recent school/college/university:

Address:

Post Code: Country:

From: _____ / _____ / ________ To: _____ / _____ / ________

Qualification achieved or
Expected:
Eg. GCSEs, Btec, International
Baccalaureate, etc.

Section 3A – Previous Education

Name of your previous

school/college/university:

Address:

Post Code: Country:

Dates studies from/to:

From: _____ / _____ / ________ To: _____ / _____ / ________

Qualification achieved or
Expected:
Eg. GCSEs, Btec, International
Baccalaureate, etc.

Section 3B - English Language

Please tick [√] the appropriate box.
Is English your first
language? Yes No

If no, please indicate which Cambridge

of the following IELTS TOEFL ESOL Other
qualifications you hold: certificate

If other, please specify:

(Please note, we may request you get an specific or additional qualification to satisfy entry requirements)

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Section 4 - Qualifications
(Please ensure you list the title of the qualification, eg. GCSEs, A Levels, International Bacclaureate, etc. – as well as the
subjects studied and grades achieved or expected)
Result Achieved or
Month Year Type of Title/Subject of Qualification or Expected
Qualification Grade
06 08 GCE A’Level English Language C Achieved
07 09 BTec National Diploma in Music Performance MMM Expected

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 Section 5 – Personal Statement
(As part of your statement, please briefly state why your chosen course is of particular interest to you)

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Section 6 – Musical Background
Intended Course:

Years Playing:

Any other instruments played:

Musical Tastes:

Musical Experience:

Musical Education: (include Private Lessons, Grades, etc.)

What are your aims and ambitions?

Section 7 – Learning Support: The Institute welcomes applications from people with disabilities or learning
difficulties and considers them on the same grounds as those from other candidates. Please note, if you do tick
yes on any of the below we may contact you for further information. The information you provide will be treated
confidentially. Please tick [√] the appropriate box.
Do you have any learning
difficulties such as Dyslexia or Yes No
Dyspraxia?

If yes, please state:

Do you have any other disabilities?

Yes No

If yes, please state:

Have you, in the past, received

any form of learning support? Yes No

If yes, please state:

Have you ever suffered from an

ailment in the past that might be Yes No
affected by prolonged
instrumental/vocal study?
(i.e. Tendonitis, Tinnitus, Vocal
Nodes, etc.)

If yes, please state:

(NB: we may ask for a medical reference)

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Do you agree that the Institute may pass information
about you to a parent or guardian: Yes No

I confirm the information I have supplied is correct to the best of my knowledge:

Signed:

Print Name:

Date:

If you are under 18 years of age, please get a parent or guardian to sign below:

Signed:

Print Name:

Date:

Please complete this form in full and bring with you to your assessment.

The Institute of Contemporary Music Performance

1a Dyne Road, London, NW6 7XG
phone: +44 (0) 207 328 0222
email: enquiries@icmp.co.uk

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