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Admissions and Access Service

International Admissions
Lanyon North
Queens University Belfast
Belfast
BT7 1NN
Northern Ireland
Tel 028 9097 5022
Fax 028 9097 5151
intl.student@qub.ac.uk
www.qub.ac.uk/ado

UK VISAS AND IMMIGRATION INFORMATION (formerly UK Border Agency)


*All applicants are required to complete and return this form*
The UK Visas and Immigration (UKVI) Department of the Home Office requires UK universities to ask
all international applicants if they have previously studied in the UK. If so, we are required to obtain
a scanned copy of each applicants passport and visa permission stamp(s).
Please can you therefore respond to the following question(s) and return the reply by email, together
with any supporting documentation (if applicable), as soon as possible to intl.student@qub.ac.uk. If
you have not previously studied in the UK, please select NO in Section A.
NAME:

APPLICATION

NUMBER:

A. HAVE YOU PREVIOUSLY


Yes
If Yes, please provide details below
STUDIED IN THE UK?
eg. degree programme, short No
If No, please tick box and return form
course, Study Abroad.
Please select appropriate box.
All applicants must complete the Declaration in Section D.
B. HIGHER EDUCATION
1. Name of College/University Attended:
Name of Course/Degree Programme:
Dates:
2. Name of College/University Attended:
Name of Course/Degree Programme:
Dates:
3. Name of College/University Attended:
Name of Course/Degree Programme:
Dates:
C. VISA DETAILS

If you answered YES to Section A above, please give date of visa


expiry and send us a scanned copy of your passport and relevant
visa stamp(s) to intl.student@qub.ac.uk. Please include all
visa stamps for each period of study listed above, even if
they have expired.
Visa Expiry Date:

(DD/MM/YYYY)

D. Declaration

I confirm that the above information is correct.


Signed:

Date: