ISMM Departmental Questionnaire

Personal information
Surname/Family name First name

Date of birth Nationality/Citizenship

Insert recent photo

Permanent address Current address

Email address valid until start of course Mobile number including country code

Academic details
High School attended with dates A2 subjects (UK educated) with grades or equivalent

University/College attended with dates Title of Degree Type of Degree Final result
(BSc, MEng etc)

Year 1 grade Year 2 grade Year 3 grade Year 4 grade

(% or GPA) (% or GPA) (% or GPA) (% or GPA)

University/College attended with dates (if applicable) Title of Degree Type of Degree Final result
(BSc, MEng etc)

Year 1 grade Year 2 grade Year 3 grade Year 4 grade

(% or GPA) (% or GPA) (% or GPA) (% or GPA)

Post Graduate Qualification (if applicable)

Work experience
Please give brief details of any paid or unpaid employment, including charity work (continue on separate sheet if necessary)
Employer Location Job title Job description/duration/date
In not more than 200 words explain how your work experience has helped to define your intended career direction

Future career plans

English Language scores obtained IELTS/TOEFL (where applicable)

Year taken Scores

Any other language capability

Additional personal information indicating any positions of responsibility & level of achievement (where applicable)
Membership of any clubs
or societies

Sporting interests

Any other hobbies or

interests

Practical experience or activities during summer vacations (where applicable)

Application information
Dates when you are unavailable for interview

Other applications being made:

This form should be completed as part of your application documents

This section asks for further information in support of your application; this information will be
considered by the department when assessing your application.
We also ask in this section how you heard about the course and, if you have submitted or intend to
submit any other applications for future study, where and what have you applied for. This
information assists us in correctly marketing and advertising our courses and does not affect the
assessment of your application.
Further guidance
Career goals

1000 characters remaining.

Additional information to support application(optional, approximately 200 words)

1000 characters remaining.

How did you hear about the course?(optional)