* Required field
First name *
Title * MrMsDrProfRev
Date of birth * (format dd/mm/yyyy)
Please add a passport image of yourself *
Accepted file types: .jpeg .jpg .png
Permanent home address *
Daytime tel *
Mobile tel *
Email address *
Emergency contact name *
Emergency contact number *
Emergency contact’s relationship to you *
Nationality * ?
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.
Number of children
Age of children
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
Degrees and Professional qualifications: with name of school, college, university and date of award. If none, please list A Levels, GCSEs or equivalent
Qualifications in Theology and Ministry (not accredited by a Higher Education Institution) eg some C of E Reader Training, Bishop’s Certificate Study: with Name of programme, Institution, Modules Studied, Award, Grade, Date of Award.
Please tick if you have done any other courses in theology (or similar) in the past and wish to have them formally recognised as part of your proposed programme at St Augustine’s.
Please give details of the modules, credits and/or level of study you wish to have accredited below.
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 SouthwarkEvening classes at West MallingTeachings days at West Malling
For full time study – choose one of the following:
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
Name of supporting diocese (for Anglicans only) CanterburyChichesterGuildfordLondonOxfordRochesterSouthwarkChelmsford
Form of Ministry Self-supportingStipendiaryOther
Name of your Diocesan Director of Training *
Have you attended a Church of England selection conference? * YesNo
Date of conference
Outcome of conference (if known)
Name of the Church you attend: *
Length of time you have been a member of the congregation: *
Minister of the Church you attend: *
Minister’s address *
Minister’s phone *
Minister’s email *
How did you hear about St Augustine’s? *