Academic Year 2015/16 Intercollegiate Application and Enrolment Form for Study at Royal Holloway College

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Academic Year 2015/16

Intercollegiate Application and Enrolment Form for Study at Royal Holloway College

A student from another University of London College (referred to as the Home College) can register to complete a course(s) at Royal Holloway College as an intercollegiate student provided:

  1. they are currently registered for a University of London degree and the course(s) they wish to study at Royal Holloway will form part of their degree programme;

  2. permission for the student to attend a course at Royal Holloway is given by the appropriate academic and administrative authorities at their Home College;

  3. permission for the student to attend the course(s) at Royal Holloway is given by the appropriate Academic Department at Royal Holloway.

Students wishing to register on a course at Royal Holloway must complete Sections A, B and C of this form and obtain the necessary signatures in Section D, before returning the form to the Senior Faculty Administrator in the Academic Department at Royal Holloway which offers the course(s) that they wish to attend. The deadline for receipt of the Application Form to Royal Holloway is 30 September 2015 for Undergraduates and 30 October 2015 for Postgraduates. Please note that it takes 4 to 6 weeks for the College to process Enrolment Forms and students will not receive access to College facilities until the form has been processed. It is therefore advised that forms should be submitted as soon as possible. Electronically scanned forms are accepted.

In addition to completing this Royal Holloway registration form, it is the student’s responsibility to ensure that they enter for the Royal Holloway examination(s) correctly with the Registry at their Home College. Failure to inform their Home College of their courses at Royal Holloway may preclude them from sitting the examinations.

Students may only attend a course that they have been registered for. The continuance of the student on the course(s) and their intercollegiate membership of Royal Holloway is conditional upon their satisfactory academic performance and compliance with the regulations of Royal Holloway College.

Prectangle 5lease complete this form electronically and print off so that it can be signed (sections C, D & E)

Tstraight connector 4itle:      

Fstraight connector 6orename(s):      

Fstraight connector 7amily name:      

rectangle 8Section A - Home College and Study Details

Cstraight connector 9ollege of the University of London

at which you are registered (Home College):      

Sstraight connector 10tudent ID number
at Home College:      

Nstraight connector 11ame of tutor/


Dstraight connector 12epartment in

Home College:      

Pstraight connector 13rogramme of study at

Home College (e.g. History):      

Level of study:  Bachelors (BSc/BA)  MSci  Masters (MSc/MA)  MPhil/PhD

Fstraight connector 15ull time / Part time:      

Dstraight connector 16ate of first registration:      

Year of study:  1st Year  2nd year  3rd Year  4th Year

Cstraight connector 17ollege e-mail address:      

Course(s) proposed to be taken at Royal Holloway:

Course Code (e.g. HS3001)

Credit Value

Course Title













Srectangle 19ection B – Personal and Contact Details

Dstraight connector 18ate of birth:      

Nstraight connector 20ationality (as on passport):      

Gstraight connector 21ender:      

rectangle 24

Disability: In order for the college to assess your current needs and facilties it offers, please select as appropriate from the following list:

 No disability

 Social/communication impairment e.g. autism

 Visual impairment

 Serious hearing impairment

 Long standing illness/condition

 Mental health condition

 Specific learning diffculty

 Combination of conditions

straight connector 22 Physical impairment (including mobility difficulties) - please specify:      

straight connector 23 Other disability/condition - please specify:      

Erectangle 25thnicity: In order to assist with the College’s commitment to equal opportunities, please tick ONE box which best describes your ethnic origin:


 White: British

 White: Irish

 White: Scottish

 Irish Traveller

 White: Welsh

 Other White background

 Black / Black British – Caribbean

 Black / Black British – African

 Other Black background

 Asian / Asian British – Indian

 Asian / Asian British – Pakistani

 Asian / Asian British – Bangladeshi


 Other Asian background

 Mixed – White & Black Caribbean

 Mixed – White & Black African

 Mixed – White & Asian

 Other mixed background

 Other ethnic background

 Information refused

Crectangle 1ontact Information:

Astraight connector 28ddress:      

straight connector 29      

Pstraight connector 30ostcode:      

Pstraight connector 31ersonal e-mail:      

Cstraight connector 32ountry:      

Tstraight connector 34elephone no:      

rectangle 3Emergency Contact Details:

Tstraight connector 35itle:      

Fstraight connector 36orename:      

Fstraight connector 37amily name:      

Rstraight connector 38elationship to student (e.g. Mother):      

Tstraight connector 39elephone no:      

Astraight connector 40ddress:      

straight connector 41      

Pstraight connector 42ostcode:      

Cstraight connector 43ountry:      

Srectangle 14ection C – Declaration to comply with the College’s Regulations

I, the undersigned, declare to the best of my knowledge the information I have given is correct and I agree to abide by Royal Holloway College’s rules, regulations and codes of practice as stated on the Reglations website. For more information please visit:

Communication – I agree to ensure my address details are up-to-date during my period at Royal Holloway and for nine months afterwards, to allow Royal Holloway to send official documentation to me when required.

Use of Data – I agree to Royal Holloway, University of London processing personal data submitted in the sign-up process, or any other data that Royal Holloway may obtain from me. I agree to the processing of such data for any purposes connected with my studies or my health and safety, or for any other legitimate reason, including disclosure of data to third parties acting on behalf or delivering services to Royal Holloway (in accordance with the Data Protection Act 1998). I authorise Royal Holloway, University of London to issue my course results to my employer or sponsor if my employer or sponsor so requests. I agree to all my work written at this institution being processed and stored by any third party Plagiarism Detection Service as appointed by Royal Holloway. Some information will be returned to the Higher Education Statistics Agency (HESA, for use in statistical anyalysis), UKVI, government education departments, funding councils, National Student Survey and other authorised users of this data. Personal information will not be released in any other cases except where in the interest of health and safety or criminal investigation.

Dstraight connector 44ate:      

Nstraight connector 45ame (printed):      

Sstraight connector 46ignature:

Srectangle 47ection D - Authorisation from Home College

For completion by the Home College’s Academic and Administrative Authorities
Please note, both parts 1 and 2 must be completed and signed, even if the same individual is approving both parts.

  1. Name and signature of an appropriate academic authority at the Home College, authorising the student named overleaf to study at Royal Holloway as part of their University of London degree programme.

Nstraight connector 51straight connector 52ame:      

Dstraight connector 53ate:      

Pstraight connector 54osition:      


straight connector 56

  1. Name, signature and College Stamp of an appropriate administrative authority at the Home College confirming that they will accept the charge (if any) as laid down by Royal Holloway in respect of the studies detailed. This section must be completed for all students, including those covered by bilateral teaching arrangements, although no charge will be made in such cases. The Home College must also indicate the tuition fee status for all students.

Fee Status of Student:  UK/EU  Overseas

Where applicable the fees will be calculated on an individual basis. However, the for for 2015/16 for a Home (UK/EU) student may be up to £1,125 per 15 credit course and for an Overseas student may be up to £1,825 for a 15 credit course.

Nstraight connector 57ame:      

Pstraight connector 58osition:      

Sstraight connector 59ignature:

College Stamp:

straight connector 61 Date:      

Srectangle 48ection E – Authorisation from Academic Department at RHUL

Name and signatures of Royal Holloway member of staff accepting this student for intercollegiate studies as detailed overleaf. IMPORTANT: This section should only be signed if all sections A-D have been completed.

Please note, by accepting this student onto a course at Royal Holloway, the Department agrees to inform Royal Holloway Student Administration if the student fails to attend teaching sessions or submit assessments.

Nstraight connector 62ame:      

Dstraight connector 63ate:      

Dstraight connector 64epartment:      


straight connector 65

Please return the completed form to
or by internal mail to Student Administration

5 May 2015

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