POINTS BASED SYSTEM APPENDIX 8 (NOV 2012)
TIER 4 (GENERAL) STUDENT
SELF-ASSESSMENT
This form is for use outside the UK only
This form is provided free of charge.
For official use only

READ THIS FIRST

This form must be completed in blue or black ink.
Please ensure you submit all relevant, original documents as indicated in the sections. It is better to explain why you do not have a document than to submit a false document. Your application will be automatically refused and you may be banned from coming to the UK for 10 years if you use a false document, lie or withhold relevant information.
You may also be banned if you have breached immigration laws in the UK. If you qualify for our differentiation arrangements you will normally be required to provide fewer evidential documents with your application. Where you are exempt from having to provide a document, or group of documents, you must still complete the relevant sections to confirm you meet the requirements and you hold the evidence in the manner required. The UKBA reserves the right to request the full range of documents from Tier 4 students in all cases.
An applicant aged over 16 and coming to study a course at or above NQF level 3 can choose to apply either as a
Child (Student) or a (General) Student and meet the appropriate criteria.
Please ensure you also complete the main Personal Details form.

Part 1

About You

1.1 Given name(s) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Part 2

1.2 Family name

Parent/Guardian details to be completed only where the applicant is 16 or 17 years old.
If applicant is 18 or over, skip to Part 3

Parent/Guardian 1
2.1 Give your parent or guardian’s given name >>>>>>>>>>>

2.2 Give your parent or guardian’s family name

2.3 Give your parent or guardian’s full contact address, >>>> including postal code.

2.4 Give details of your relationship to your guardian
(leave blank if you do not have a guardian)

Parent/Guardian 2 (if applicable)
2.5 Give your parent or guardian’s given name >>>>>>>>>>>

2.6 Give your parent or guardian’s family name

2.7 Give your parent or guardian’s full contact address, >>>> including postal code.

2.8 Give details of your relationship to your guardian
(leave blank if you do not have a guardian)

01

2.9 Give the full address of where you will be residing in the
UK including the postal code. If this is not known and your
Tier 4 sponsor is arranging your accommodation give the contact details of the person doing this, and/or the temporary address you will use on arrival.

2.10 You must provide a letter of consent to this application from your parent(s) or legal guardian. Put a cross (X) in the box to confirm you have done so (See the Tier 4 Policy Guidance for details of what this must contain).

2.11 Will you be travelling to the UK alone? Put a cross in the relevant box
Yes - Go to Part 3

No - Complete Question 2.12

2.12 Provide full details of up to two adults who will accompany you
Full name
Full name

Address including postal code

Address including postal code

Telephone No.

Telephone No.

Nationality

Nationality

Passport No

Passport No

Exact relationship to you

Exact relationship to you

Part 3

Tier 4 Sponsor (Education Provider) contact details

3.1 Give the full name of your Tier 4 Sponsor

3.2 Give your Tier 4 Sponsor’s Licence Number >>>>>>>>>>

3.3 Give the full address of your Tier 4 Sponsor including postal code

02

Part 4

Course details

4.1 Give the title of your course of study >>>>>>>>>>>>>>>

4.2 Give the academic level of the course or qualification awarded when the course is finished. For example the National
Qualification Framework level; or for English language course the
CEFR level should be given e.g. B2.

4.3 Give the start and end dates for your course of study >>>
From

4.4 Give the full address of your primary site of study, including postal code. See the