Registration Form Section A


Personal details Family or last name ___________________________________________________________


First name_______________________________________ Date of birth ____________ Middle name/s___________________________________ Nationality_______________________________________


Address for correspondence____________________________________________________ _______________________________________________________________________________


Telephone number_____________________________________________________________ Email Address_________________________________________________________________


Course details Middlesex University student number ______________________________________


Name of Programme/Course you will be taking at Middlesex University___________ _______________________________________________________________________________ At which campus will you be studying _____________________________________ Have you been issued with a student visa? If Yes, please provide CAS/Visa number? _______________________________________________________________________________


Have you applied for accommodation in the university halls of residence? Yes c No c (please tick) Which hall? ______________________________________


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