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 2018. To see our privacy policy click here.

Please choose your diocese*
ChichesterCanterburySouthwark

First name*

Middle name

Surname*

Title*
MrMsMrsDrProfRev

Date of birth*

Please add a passport image of yourself*

• 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)

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

Preference for regular (shared modules) – choose one option*
Evening classes at Southwark (Monday evenings – 6:30pm-9pm)Online classes (Wednesday evenings – 6:30pm-9pm)Teaching days at West Malling (15 Fridays throughout the year 10:30-4pm)

Qualifications in Theology and Ministry (not accredited by a Higher Education Institution) e.g. 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 the 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.

GCSE’s & A-Levels: Please list all your GCSEs and A-Level qualifications, or equivalents, include grade and year studied.

Name of the Church you attend*

Length of time you have been a member of the congregation*

Minister/incumbent of the Church you attend*

Minister/incumbent’s address*

Minister/incumbent’s email*

Minister/incumbent’s phone*

I agree to the terms of the Privacy Policy (required)