Application for an MPhil/PhD Research Degree (self funded) –

2010/11

FOR OFFICE USE

• Part-time registration* ONLY

Received by
• 1st January 2012* Graduate
School
• If a member of Staff in the University, please
indicate department:
Sent to
___________________________ Academic
Department
• Subject Area/Academic Discipline of Application:

_______________Applied Linguistics_____________________ Dept wish to

pursue
application:
Yes/No

1. PERSONAL DETAILS

Mr/Mrs/Miss/Ms: Mr Family/second name: Derry

First name(s) Bryan Previous/maiden name: N/A

Date of Birth: July 29th, 1979

Citizenship ____________________________ Is English your native language? YES/NO

Address (home) ____________________________________________________________________

____________________________________________________________________________________

________________________________________ Telephone ______________________________

Contact address (if different from above) _______________________________________________

__________________________________________Telephone ______________________________

Email address: _____________________________________________________________________

If you are an overseas student please give details of the bank or other body which will
provide financial guarantees:
_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

2. EDUCATION
Please give details below of your education since A-Levels in chronological order:

College/ Dates Qualification Principal subjects Date of Level

University eg. BA, MSc Award eg. 2(i)

3. EMPLOYMENT DETAILS

Please list your employment to date, starting with your present or most recent position.

Employer's name and Dates from and to Position/Principal duties

address

4. PROPOSED RESEARCH
Proposed supervisor:
____________________________________________________________________
(if known)

Have you had an advisory interview with a potential supervisor at the University?
YES/NO

If so, please name the member of staff and date of interview:

_________________________________________________________________________________________

Subject of research: _______________________________________

Provisional title of research:

Please attach a 1500 word proposal which must be completed following the
University guidelines enclosed.
5. REFERENCES

Please provide the names and addresses of two referees who are familiar with your
academic work and to whom you have sent the referees report forms, which are
enclosed in the pack (please note that your proposed supervisor should not also be a
referee): YOUR APPLICATION WILL NOT BE PROCESSED UNTIL WE HAVE
RECEIVED BOTH REFERENCES.

Name: (i) _______________________________ (ii)

________________________________

Position: _______________________________ ________________________________

Address: _______________________________ ________________________________

_______________________________ ________________________________

_______________________________ ________________________________

________________________________ ________________________________

Telephone: ________________________________ ________________________________

6. DECLARATION BY CANDIDATE

I undertake, if admitted to the University, to abide by the regulations of Canterbury

Christ Church University and of the validating body granting the degree.

Date: ________________________ Signature: _________________________________________

Please return completed forms to:

The Graduate School Secretary

Canterbury Christ Church University
The Graduate School
North Holmes Road
Canterbury
Kent CT1 1QU
Email: helen.potter@canterbury.ac.uk
 EQUAL OPPORTUNITIES POLICY

Name:

Canterbury Christ Church University has an Equal Opportunities Policy. We want to

ensure that all applicants are treated equally regardless of their sex, race, colour, ethnic
origin or disability.

To do this, we need to know about the people who apply to us, and therefore would be
grateful if you could complete the following questions. Your answers will be detached
from your application form on receipt, and used solely to evaluate the effective
operation of the College’s Equal Opportunities Policy. Your answers will NOT affect your
application in any way.

Please show which group best describes your ethnic origin or descent by ticking only
one of the boxes below:

ARE YOU:

• Indian

• Pakistani

• Bangladeshi

• Chinese

• Asian - other (please specify)

• Black - Caribbean

• Black - African

• Black - other (please specify)

• Mixed Race

• White - UK/Irish

• White European

• White-other (please specify)

Do you belong to • (please describe)

any other group?

Are you: • Male/Female

Do you have a disability? • Yes/No

 CANTERBURY CHRIST CHURCH UNIVERSITY

Application for registration for an MPhil/PhD Research Degree REFEREE'S

REPORT

Please comment as fully as possible on the candidate and his/her application for MPhil/PhD
registration. You should keep in mind the following points for inclusion:

(i) Your views on the candidate's suitability for postgraduate training in general and for the
particular research he/she proposes to undertake.

(ii) Information on how, and to what extent, the candidate has shown academic ability in
terms of:
(a) ability to grasp concepts and reason analytically;
(b) motivation and perseverance in achieving objectives;
(c) capacity for original thought.

(iii) Your estimate of his/her likely first degree result, if this degree has not yet been obtained,
or if the degree has been obtained, your view on whether the result accurately reflects the
candidate's ability.

(iv) An assessment of the candidate's particular strengths and weaknesses, and on the
training the candidate will require to successfully complete their research.

Please also say how long, and in what capacity, you have known the candidate.

NAME OF APPLICANT:

Continue overleaf....

Signed: ....................................................................................................
Date: ..........................

Name: ...................................................................................................................................
..................

Position: ................................................................................................................................
..................

Institution: ..............................................................................................................................
.................

................................................................................................................................................
............

Please return completed forms to: Graduate School Secretary, The Graduate School,
Canterbury Christ Church University, North Holmes Road, Canterbury CT1 1QU