Application for Independent Study

The information that you provide will be used for the purpose of processing your application and maintaining your student record. Personal information will not be sold or provided to marketing companies. Personal information collected is held in accordance with the provisions of the Data Protection Act 1998. To see our privacy policy click here.

First name *

Middle name

Surname *

Title *
MrMsMrsDrProfRev

Date of birth (dd/mm/yyyy) *

Please add a passport image of yourself *
Accepted file types: .jpeg .jpg .png

• The photograph should be a head and shoulders passport style photograph with a plain, white background.
• You should be looking straight into the camera, with the picture clear and in sharp focus.
• Your eyes should be open and you should not be wearing sunglasses or tinted lenses.
• Your clothes should contrast the colour of the background.
• You should not be wearing a hat or other items of clothing that obstruct your face. Your face must not be obstructed or covered by anything else.
• Photographs should be in colour.

Permanent home address *

Daytime tel *

Mobile tel *

Email address *

Emergency contact name *

Emergency contact number *

Emergency contact’s relationship to you *

Nationality * ?

Ethnicity*
SelectWhiteGypsy or TravellerBlack or Black British – CaribbeanBlack or Black British – AfricanOther Black BackgroundAsian or Asian British – IndianAsian or Asian British – PakistaniAsian or Asian British – BangladeshiChineseOther Asian backgroundMixed – White and Black CaribbeanMixed – White and Black AfricanMixed – White and AsianOther Mixed backgroundArabOther Ethnic BackgroundNot KnownInformation Refused

Is English your first language? *
YesNo

Note: If you are not a native English speaker you are required to demonstrate competency in English Language for entry to Durham common Awards Programmes. Please see https://www.dur.ac.uk/learningandteaching.handbook/1/3/3/1/ for details of accepted English language proficiency tests.

Please provide details of any relevant qualifications.

If you do not have an English Language Proficiency Test but believe you can demonstrate proficiency in English Language in other ways, please give details.

Learning support – Completion of this section is optional ?

Have you been diagnosed with or think you may have a specific learning difficulty (SpLD), disability or medical condition which may affect your capacity to study? *
YesNo

If yes please give brief details.

If yes do you have a diagnostic report? *
YesNo

Dietary requirements (if any)

Have you previously studied with St Augustine’s? *
YesNo

If yes, which course did you study, and in which years?

Please give details of the modules, credits and/or level of study you wish to have accredited below.

Degrees and Professional qualifications: with name of school, college, university and date of award. If none, please list A Levels, GCSEs or equivalent

Which course are you applying for? *
Ministry and Mission (Independent student pathway: fees £2,700 per year part time; £5,400 full time)
Certificate in TheologyBA in TheologyGraduate Diploma in TheologyMA in Theology

Please choose either part time or full time study *
Theology Ministry and Mission (part time)Theology Ministry and Mission (full time)

For part time study – choose one of the following:

• Evening classes at Southwark (Monday evenings – 6:30pm-9pm)
• Evening classes at West Malling (Wednesday evenings – 6:30-9pm)
• Teachings days at West Malling (15 Fridays throughout the year 10:30 – 4pm)

Evening classes at SouthwarkEvening classes at West MallingTeachings days at West Malling

For full time study – choose one of the following:

• Teaching days at West Malling (30 Fridays 10:30-4pm)
• 2 sets of evening classes one at Southwark (Monday evenings 6:30pm-9pm) and one at West Malling (Wednesday evenings 6:30-9pm)
• 1 set of teaching days at West Malling and evening classes at Southwark Cathedral (Monday evenings 6:30pm-9pm)
• 1 set of teaching days at West Malling and evening classes at West Malling (Wednesday evenings 6:30-9pm)

Teaching days at West Malling2 sets of evening classes1 set of teaching days plus Southwark evening classes1 set of teaching days plus West Malling evening classes

Reference 1 Name *

Reference 1 Address *

Reference 1 Relationship to you *

Reference 1 Telephone *

Reference 1 Email *

Reference 2 Name *

Reference 2 Address *

Reference 2 Relationship to you *

Reference 2 Telephone *

Reference 2 Email *

How did you hear about St Augustine’s? *

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