Immigration Information Form

Have you previously applied for a visa to enter or remain in the UK?

Where are you planning to submit your visa application from?

Do you currently have a visa applicationpending with the Home Office?

Yes

No

Inside the UK

Outside the UK Country:______________

Yes

No

Have you ever taken an Educational Testing Service (ETS) TOEIC test? (NB this is NOT IELTS – please read website before answering: https://www.ets.org/toeic)

If you are eligible, will dependents be joining you to the UK while you study (e.g. spouse, partner, children)?

Yes

No

Yes Number _____

NoHave you ever had a visa refused? Visa refusal grounds and reason:

Yes If yes, please provide details here

No

Do you have any criminal convictions? Criminal conviction grounds and reason:

Yes If yes, please provide details here

No

Before completing this form, please read the document ‘Tier 4 Sponsorship and the issuing of Confirmation of Acceptance for Studies (CAS)’ which outlines LSBU’s position on the issuing of CAS to students: http://www.lsbu.ac.uk/about-us/policies-and-initiatives Section: ‘Tier 4 Regulations for international students’

Please answer all questions and sections which are relevant to you. Please state ‘N/A’ if the question is not applicable to you.

It is essential that you complete this form. The information is required in order to proceed with your admission to and enrolment at the University. Your offer may be withdrawn if you already hold an offer and fail to submit this form.

Please attach all relevant documentation regarding your immigration history (e.g. copies of all UK visas, enrolment/CAS letters, completed UK qualifications, permission to switch, refusal letter, appeal letters, academic progress, Home Office correspondence etc. as appropriate)

Applicant DetailsLSBU ID

Name

Date of Birth

Programme

Immigration Information Form

Important :If you have previously applied for a visa to enter or remain in the UK, please include details of all UK visas that you have been granted, and complete the form clearly and accurately. For non-Tier 4 visas (e.g. Visit, Tier 2) you only need to complete the first three columns highlighted in bold.

Give as much information as you can in the table below. There is space below to give more details should it be necessary.

Visa type (1)

Visa start date

Visa end date

Name of Course Visa was issued for

Institution name Level of study (2)

Course start date (actual) (3)

Course end date

Qualifications completed whilst on this visa e.g. PGDip, BSc, MSc

If any of the following apply to you, please give a detailed explanation in the Notes box below:

(2) e.g. Please include the NQF level, or if you studied English Language Course the CEFR level e.g. B1 or B2. The level of Study will be stated on previous CAS Statements.

(1) e.g. Tier 4 Student, Student Visitor, Student visa, Tier 1 Post Study Work visa

(3) Please state the actual course start date. This maybe different to what is stated on the course CAS statement.

Immigration Information Form1. There are gaps in your immigration history;2. You have failed to complete a course that you were sponsored for;3. You completed a course for which you were not originally sponsored for;4. Any further relevant information you would like to state

Notes

By signing below you assert the following:

- I have read and understood the document ‘Tier 4 Sponsorship and the issuing of Confirmation of Acceptance for Studies (CAS)’ (available here: https://my.lsbu.ac.uk/my/applicant/Current-Applicants/Regulations)

- I have attached all relevant documentation regarding my immigration history. (Including, but not limited to: copies of all UK visas, enrolment/CAS letters, completed UK qualifications, permission to switch, appeal letters, academic progress, Home Office correspondence etc. as appropriate.)

- I confirm that the information given in this form is correct and complete. I understand that the University reserves the right to withdraw any offer or cancel a registration made on the basis of the information which proves to be false or misleading.

Signature: (must be hand written*) Date: (must be hand written*)

_______________________________________ __________________________________________

*Electronic signatures are not accepted