Henley Postgraduate-certificate Form

Programme details

Although you are initially applying for the PGCert, it will be helpful for us if you can indicate whether you are interested in continuing onto the PG Diploma and/or MA qualification. This will help give us an idea of your journey on the programme. It is only an indication at this point and you will be able to change your mind as you go through the programme.

I am interested in carrying on to the PG Diploma

I am interested in carrying on to the MA

About You

Please provide your personal details. This information will form the basis of your student record with us. It will ensure that your details are correct for statistical reporting purposes.

Title (Mr/Mrs/Ms/Miss/other) *

Surname (Family name) *

Forename/s (First name/s) *

Preferred forename *

Date of birth (dd/mm/yyyy) *

Disability (please state if you have any disability that may affect your learning) *

Nationality *

Country of birth *

Country of permanent residence *

Gender *

Ethnic origin (UK & EU nationals only) *

Home Address Details

Please provide your home address details as well as an alternative contact address details (if you wish them to be different to your home address). If you wish us to use your home address details for your contact address details, you do not need to provide the address twice.

Home address *

Country *

Postcode *

TelePhone *

Mobile *

Please indicate if you wish your home contact details or employment contact details to be used as your main contact:

Email address *

About your employment

Please provide information on your current role as well as detail on what organizational Board-level experience you have (this could be as a member or as someone with access to the Board). We will also require a copy of your CV in order to look at your career progression and previous experience.

Job title *

Employer *

Office address *

Country *

Postcode *

Telephone *

Email *

Please describe your current duties *

Please tell us about your board level experience *

About your education and professional qualifications

Please provide information on your education as well as any relevant professional qualifications that you might hold.
What to include: We need information on your degree (or higher-level) qualifications. If you have any professional qualifications that you feel are relevant please do provide information on those also. Proof of your degree (or high-level) qualifications will also be needed (a copy of the official certificate/ transcript along with certified English translations (if applicable)).

Educational Qualifications (Qualification - e.g. Bachelors, Masters, Result/Grade, Institution, Date Started, Date Finished) *

Professional Qualifications (Qualification - e.g. ACCA, Institution/Organization, Date Started, Date Finished) *

About your English language proficiency

All participants are required to be at a certain standard of English Language ability in order to undertake the programme. Please provide information on your English language ability below. The University accepts a wide range of English Language tests as evidence of English Language ability and these can be found at www.reading.ac.uk/ad-englishtests.aspx.
In exceptional circumstances we will accept a suitably signed English Proficiency at Work form as evidence of English Language ability. This form declares that English is the main language of your organization and you are required, on a daily basis, to write and speak in English to a high standard.

Is English your first language? *

If no, have you taken an English Language test? *

Date test taken *

If you have not taken a test are you able to provide a signed English proficiency at work form (as noted above) *

Your referees

When considering applications, we value the comments (in the form of a written reference statement) of two independent people.
They should be individuals who have experience of your management and leadership, in a professional setting. Ideally, they should be able to comment on your suitability for a place on the PGCert in Board Practice and Directorship. Please do provide two references along with your application or indicate if they are to follow. Please also provide each referee’s details below in case we need to contact them directly.

Referee one name *

Referee one position *

Referee one organisation *

Referee one email address *

Referee one relationship to you *

Referee two name *

Referee two position *

Referee two organisation *

Referee two email address *

Referee two relationship to you *

Supporting and additional documentation

Please indicate below that you are submitting the required additional information alongside this application form.
Please note that copies of official certificates/ transcripts are acceptable – you are not required to send originals. We will require certified English translations of documents if they are not already in English.
Preferred file types are .pdf, .doc, .docx, .rtf, .txt, .jpg and should be no bigger than 10Mb.

Your CV *

Your Degree (or higher level qualification) certificate *

Degree (or higher level) transcript *

Personal Development Plan *

English Language Certification *

Referee One *

Referee Two *

Information for invoicing

Should you be successful and receive an offer of a place, an invoice will be sent with your offer documents. Please confirm below the details for billing purposes.
If company sponsored (including if you are paying by your own company) please complete the details below. If you are paying personally (not through a company) please leave blank and you will be invoiced based on your personal details.

Confirm who is paying (My Company/Paying personally/Shared)

Percentage or monetary split (in GBP) if shared: You/Company

Purchase order number (if applicable)

Company contact name

Company contact address for invoice

Company contact email address for invoice

Fiscal code or VAT number (if needed on invoice)

Commerce Registry number (if needed on invoice)

Declaration

I declare that the information given on this form is true, complete and accurate and that no information requested, or other material, has been omitted.
Note: If any information on your application form is found to be false, it may lead to the withdrawal of your place at the University.

Signature *

Date *

Mentions

Please return this completed application form, along with additional documentation to your contact at Envisia.
The personal information you supplied will be used to help us respond to your request, for quality assurance and for data analytics purposes. Your personal data will not be sold to any organization and will not be shared with any organizations outside the University of Reading apart from those that help us to provide this service or unless required by law. The information that has been provided in this form will be treated in accordance with the General Data Protection Regulation (2016), the UK Data Protection Act 2018 and all applicable Data Protection laws. Please refer to the University of Reading at (www.reading.ac.uk/15/about/about-privacy.aspx) for more information

Postgraduate Certificate