Insert NSIRC Reference/Code

NATIONAL STRUCTURAL INTEGRITY RESEARCH CENTRE (NSIRC)

APPLICATION FORM

NSIRC is an industrial driven education and research centre for postgraduate research into structural
integrity. Funded in part by UK Government, controlled and administered by SIRF and based at Granta Park
in Cambridge, NSIRC provides a purpose built facility and state of the art equipment for fundamental
research. In order to be considered eligible to enrol at NSIRC it is necessary to satisfy the following criteria:-

Please print clearly in black ink

1. Course to be undertaken

University _______________________________________________________________

PhD ____ EngD ____ MPhil ____ MSc ____ Other ____

In the Department of _______________________________________________________________________

Course Title ________________________________________________________________________________

Proposed Start date _ _ / _ _ / _ _ _ _ Expected completion date _ _ / _ _ / _ _ _ _

Proposed mode of Study Full Time______ Part Time______

2. Personal details

Surname/Family Name (BLOCK

CAPITALS) ___________________________________________________

First Name (s) ____________________________________ Title____________ (Mr/Ms/Miss/Mrs etc.)

Previous surname (if changed) _______________________________________________________________

Permanent Address ______________________________________________________________________

________________________________________________________________________________________

City/Town______________________________________ Postcode__________________________________

Country _______________________________________ Telephone (day) ____________________________

Telephone (eve) ________________________________ E-mail ____________________________________

Correspondence Address (if different) ________________________________________________________

________________________________________________________________________________________

City/Town____________________________________ Postcode____________________________________

Country _____________________________________ Telephone (day) ______________________________

NSIRC Enrolment Form Ver. 03A-13 © NSIRC, 2013

 3. Academic qualifications

Please list first and any higher degree awards, in chronological order

Level, e.g. degree Results

Where University/College/Awarding Year
or Professional Subject (grades or
studied body Taken
Qualification bands or GPA)

4. Research Brief description of area of research you are planning to undertake and if you have any previous
practical experience in this field

5. Supervisors

Please complete the table based on the different institutions that the student will be based when undertaking
the course

NSIRC/University/Other Third Party Percentage of time spent here

Duration
Company (please specify) throughout the course (%)

I confirm that the forecasted course duration and percentage of time the student will spend at the different institutions
detailed in the table above are correct to the best of my knowledge
6. Declarations
Academic Supervisor ________________________________________________________________________
I confirm that the information given in this form is true, complete and accurate and no information requested or other
TWI Supervisor (if known) _____________________________________________________________________
material information has been omitted. I give my consent to the processing of my data by TWI Ltd for NSIRC.

Applicants Signature _______________________________________________ Date _ _ / _ _ / _ _ _ _

I confirm that the student identified is enrolled to undertake the course identified and that 50% of the time enrolled on
the course is planned to be undertaken on site at Granta Park, Cambridge.

Supervisor Signature _______________________________________________ Date _ _ / _ _ / _ _ _ _

TO BE COMPLETED BY STAFF OF NSIRC ONLY

NSIRC course Eligible Studentship Agreement Recorded Initials ____ Date_ _ / _ _ / _ _ _ _

TWI Ltd is collecting this information to help assess and process your NSIRC enrolment and will be held on the enrolment file
and used for interview purpose. Access to the information you provide will be restricted to a limited number of authorised TWI
Ltd staff. If unsuccessful your enrolment form will remain on the reenrolment file and be destroyed after one year.

Your information will be processed and stored (by means of a computer database or otherwise) as described above, for the
duration of your enrolment and to fulfil the statutory, or recommended, retention periods when you are no longer enrolled at
NSIRC. If you have any concerns about your personal information please contact data.protection@twi.co.uk

NSIRC Enrolment Form Ver. 03A-13 © NSIRC, 2013