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

READ THIS FIRSTThis 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 aChild (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 yourTier 4 sponsor is arranging your accommodation give thecontact 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 applicationfrom 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 fordetails 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 3Tier 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 code02

Part 4Course 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 Tier 4 Policy Guidance for an explanation ofprimary site of study.

D

D

M M

Y

Y

Y

Y

D

M M

Y

Y

Y

Y

To

D

4.5 Have you already started studying this course?
Put a cross (x) in the relevant box
Yes

Part 5No - Go to Part 5

Attributes You should refer to the Immigration Rules and the Tier 4 Policy Guidance.
You require 30 points from this part, or your application will be refused.

5.1 Confirmation of Acceptance for Studies (CAS) Select to confirm you are claiming points for having a valid Confirmation >>>of Acceptance for Studies, Put a cross (X) in the box
5.2 What is your Confirmation of Acceptance >>>>>>>
for Studies Number?
5.3 Confirm which of the following options applies. Put a cross (x) in the relevant box
Undertaking a post as a Sabbatical Officer
Studying - Go to Question 5.4
Go to Question 5.6
Undertaking a foundation programme as a Postgraduate
Doctor or Dentist - Go to Question 5.6
5.4 Unless you are exempt under differentiation arrangements, you must send all of the original certificate(s) of qualification
and/or original transcripts of results and/or references that are listed in the CAS. You must get this information from your Tier 4sponsor.
Put a cross (X) in the box to confirm you have done so if thisapplies to you

Put a cross (X) in the box to confirm evidence not required
under guidance, but held by applicant.

5.5 Have you been assessed by your sponsor by other means, for example by progress on a continuing course of study, as
part of a study abroad programme, by your sponsor’s internal test, a portfolio of artwork, or other means as stated on your CAS(state which)? (Please do not submit this) Put a cross (X) in the relevant box.
Yes - Say how you have been assessed in the space below
then Go to Question 5.6

No - Go to Question 5.6

English language abilityYour sponsor must ensure that you are competent in English language before assigning you a CAS. Your sponsor must checkyou are competent at a minimum level of CEFR B1 for courses below NQF level 6. (This also applies if you are studying an
English language course, a pre-sessional course before a degree and a foundation degree), and at CEFR level B2 for courses at
NQF level 6 and above. The English language requirement may be waived if you are considered to be a gifted student by yoursponsor, you are studying at a Higher Education Institution (HEI), and authorisation has been given by the academic registrar.
Before completing this section of the form you should refer to the Immigration Rules and Tier 4 policy guidance to check how
your English level has been assessed.

035.6 Put a cross (X) in one box to indicate how you meet the minimum English language requirement relevant to your course.
National of a majority English speaking country - Go to Question 5.7
Academic qualification equivalent to UK degree, taught in majority English speaking country - Go to Question 5.8
English language test - Go to Question 5.10
Previous study as a child student (or under the student rules that were in force before 31 March 2009) - Go to Question 5.12
Your sponsor is a Higher Education Institution, and has made its own assessment of your English language ability - Go to
Question 5.14
Your sponsor is an HEI, considers you to be a gifted student and has waived the English language requirement.
Your CAS must confirm that the Academic Registrar has approved the waiving of the language requirement. - Go to Question 5.14
5.7 Majority English speaking country.
Antigua and Barbuda; Australia; The Bahamas; Barbados; Belize; Canada; Dominica; Grenada; Guyana; Jamaica;
New Zealand; St Kitts and Nevis; St Lucia; St Vincent and the Grenadines; Trinidad and Tobago; The United States of America
If you are a national of one of the countries listed above you are deemed to have the appropriate standard of English language
Give your nationality This should be the nationality shown in the passport/travel document you wish to use for this application.
Go to Question 5.14
5.8 Academic qualification equivalent to UK degree, taught in majority English speaking country
Antigua and Barbuda; Australia; The Bahamas; Barbados; Belize; Dominica; Grenada; Guyana; Ireland; Jamaica;
New Zealand; St Kitts and Nevis; St Lucia; St Vincent and the Grenadines; Trinidad and Tobago; United Kingdom;
The United States of America
If you have completed an academic qualification at least equivalent to a UK Bachelors degree which was taught in one of thecountries listed above you are deemed to have the appropriate standard of English
Give your academic qualification and the country it was taught in

5.9 Put a cross (X) in the box to indicate what evidence you have supplied
Evidence not required under guidance but held by applicant
Original test certificate
Go to Question 5.14
5.10 English language test. For a list of acceptable tests see the link in the Tier 4 Policy Guidance. Provide details of the test taken:
Title of qualification
Awarding Body >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Level of qualification >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Date of Award

D

D

M M

Y

Y

Y

Y

Award reference number

5.11 Put a cross (x) in the box to indicate what evidence you have supplied
Evidence not required under guidance but held by applicant
Original test certificate - Go to Question 5.14
Go to Question 5.14

04

5.12 Please give details of your previous place of study and course that you successfully completed as a Tier 4 (Child) student(or under the student rules that were in force before 31 March 2009, where you were granted permission to stay whilst you were
under 18 years old) which was:• At least six months in length; and• Ended within two years of the date the sponsor assigned your Confirmation of Acceptance for Studies.
Name of Institution >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Title of Course

Qualification

Year of Award

Y

Y

Y

Y

End date

D

D

Date of Award
Start date

D

D

M M

Y

Y

Y

Y

M M

Y

Y

Y

Y

5.13 Put a cross (X) in the box to indicate what evidence you have supplied
Original course certificate

Evidence not required under guidance but held by applicant

ATAS certificate
5.14 Are you required to obtain permission from the Academic Technology Approval Scheme (ATAS)? (See the Tier 4 Policy
Guidance for the circumstances when this is required) Put a cross (X) in the relevant box.
Yes - Go to Question 5.15

No - Go to Part 6

5.15 Put a cross (X) in the box to confirm you have provided the original of your Academic Technology Approval >>>>>>>
Scheme (ATAS) clearance certificate. Then Go to Part 6
Sabbatical Officer
5.16 Put a cross (X) in the box to confirm you are applying as a Sabbatical Officer. Then Go to Part 6 We will use the >>>>>
Confirmation of Acceptance for Studies from your sponsor, provided in Question 5.1, as evidence.
Postgraduate Doctor or Dentist
5.17 If you intend to be a Postgraduate Doctor or Dentist we will use the CAS from your sponsor provided in Question 5.1.
You must send us all of the original certificate(s) and/or original transcripts of results of your United Kingdom qualification in
Medicine or Dentistry that are listed in the CAS.
Put a cross (x) in the box to confirm evidence not required
under guidance but held by applicant

Put a cross (X) in the box to confirm you have done so.

Part 6

Maintenance (Funds) You must have a minimum level of funds to cover your course fees and support
yourself. You should refer to the Immigration Rules and the Tier 4 Policy Guidance. You need 10 points from thispart, or your application will be refused.

6.1 How much are the fees for your course of study? The figure should be the same as in the CAS
which will be used as the specified evidence for this. If you will be studying at a Residential Independent
School this will include course fees and boarding or lodging fees.

£• If you are beginning a new course give the fees for the first year of the course, or for the entire course, if it less than one year’s duration.
• If you are a applying for a further period of leave to continue an existing course, give the course fees that you still need to pay to the endof the current academic year, if you are part way through the year; or for the next academic year if you will continue on your course at
the start of the next academic year. If you have no course fees to pay put £0.00 in the box.
• If this will be part of a study abroad programme give any fees you will be required to pay to the UK education provider for the first year of
your course, or for the entire course, if it is less than one year’s duration.
• If you have no fees to pay the UK education provider put £0.00 in the box.
6.2 Have any of your course fees been paid? Put a cross (X) in the relevant box.
Yes - Paid to Overseas Higher Education Institution
Yes - Paid to UK Education Provider. Enter the amount in the(Zero fee on CAS) - Go to Question 6.3
box below then - Go to Question 6.3£

No - Go to Question 6.4

6.3 Put a cross (X) in the relevant box to show what document has been provided as evidence of payment.
Shown in the CAS

An official, original receipt

Evidence not required under guidance but held by applicant

05

6.4 Put a cross (X) in the box to confirm you have sufficient funds to cover remaining course fees due for payment. >>>>>>
6.5 Do you have an established presence in the UK? Put a cross (X) in the relevant box.
Yes - Go to Question 6.9

No - Go to Question 6.6

6.6 Initial application
Put a cross (X) in the relevant box to confirm your primary site of study. See the Tier 4 Policy Guidance for an explanation of the Inner
London Boroughs and how to assess your primary site of study.
Inside the Inner London Boroughs
Go to Question 6.7

Outside the Inner London Boroughs
Go to Question 6.8

6.7 You must have £1000 per month to cover >>>>>>>>>>>>>
maintenance in the UK (up to a maximum of 9 months).
See the Tier 4 Policy Guidance for a full explanation of maintenancecharges. Calculate the amount you will require and enter this in thespace provided. Go to Question 6.12

6.8 You must have £800 per month to cover maintenance inthe UK (up to a maximum of 9 months).
See the Tier 4 Policy Guidance for a full explanation of maintenancecharges. Calculate the amount you will require and enter this in thespace provided. Go to Question 6.12££

6.9 Extension application (established presence)
Put a cross (X) in the relevant box to confirm your primary site of study. See the Tier 4 Policy Guidance for an explanation of the Inner
London Boroughs and how to assess your primary site of study.
Inside the Inner London Boroughs
Go to Question 6.10

Outside the Inner London Boroughs
Go to Question 6.11

6.10 You must have £1000 per month to cover >>>>>>>>>>>>
maintenance in the UK (up to a maximum of 2 months).
See the Tier 4 Policy Guidance for a full explanation of maintenancecharges. Calculate the amount you will require and enter this in thespace provided. Go to Question 6.12

6.11 You must have £800 per month to cover maintenance inthe UK (up to a maximum of 2 months).
See the Tier 4 Policy Guidance for a full explanation of maintenancecharges. Calculate the amount you will require and enter this in thespace provided. Go to Question 6.12££

6.12 Have any of your accommodation fees been paid to your sponsor? Put a cross (X) in the relevant box.
Yes - Paid to UK Education Provider. Enter the amount in
Yes - Paid to Overseas Higher Education Institution
the box below then - Go to Question 6.13
Go to Question 6.13£

see Tier 4 guidance for limit

No - Go to Question 6.14

6.13 Put a cross (X) in the relevant box to show what document has been provided as evidence of payment.
Shown in the CAS

An official, original receipt

Evidence not required under guidance but held by applicant
6.14 Showing funds
Do you receive support from a financial sponsor that meets the UK Border Agency definition of a financial sponsor?
(See Tier 4 Policy Guidance for definitions) Put a cross (X) in the relevant box
Yes - Provide name of official financial sponsor

No - Go to Question 6.17

6.15 Put a cross (X) in the relevant box to confirm what evidence of financial sponsorship you have provided.
An original letter to confirm the financial sponsorship from an official financial sponsor or Government sponsor.
You are receiving official financial sponsorship from your Tier 4 licensed sponsor (e.g. a scholarship or bursary), and details of thefinancial sponsorship are included in the CAS.
Evidence not required under guidance, but original letter to confirm the financial sponsorship from an official financial sponsor orgovernment sponsor, held by applicant
Go to Question 6.16

06

6.16 Complete the box(es) to indicate how much the official financial sponsor or Government sponsor is paying towards yourexpenses.
For Maintenance
For Course fees££

6.17 Do you have any remaining fees and maintenance still due for payment? Put a cross (X) in the relevant box.
No - No money due, no evidence needed
Yes - Complete the boxes below
Go to Part 7
Course fees >>>>>>>>>>>>>>>>>£

Maintenance >>>>>>>>>>>>>>>>>£

Total >>>>>>>>>>>>>>>>>>>>>>>£

6.18 Do you have money in your own name? Put a cross (X) in the relevant box.
Yes - Go to question 6.20

No - Go to question 6.19

Have money in parent / legal guardians bank account.
Go to question 6.19
6.19 Put a cross (X) to confirm what evidence you have provided
A letter from your parent or legal guardian

Evidence not required under guidance but held by applicant

Put a cross (X) to confirm that you have provided one of the following pieces of evidence of the relationship.
Court document naming the student and the legal
Birth Certificate naming Student and Parent(s)guardian(s)Certificate of adoption naming the student and the adoptive
parent(s)Evidence not required under guidance but held by applicant

6.20 Put a cross (X) in the relevant boxes to indicate what evidence of funds has been supplied to cover all maintenance and fees
which you still need to pay. All documents must be originals. The funds must have been in your (or your parent or legal guardian’s)bank account/building society account for 28 days ending no more than 1 month prior to the date of your application.
Personal bank or building society statements

Savings or building society pass books

Letter from a bank or building society confirming the funds
or the agreement of a loan

Letter from a regulated financial institution confirming funds
or the agreement of a loan.

Evidence not required under guidance but held by applicant

Translations
Any documents that have to be submitted in support of points claimed, which are not in English or Welsh must be accompanied by afull translation that can be independently verified by the UK Border Agency. The original translation must contain confirmation from thetranslator that it is• an accurate translation of the original document• the date of the translation• the translator’s full name and signature, and• the translator’s contact details.

07Part 7

Summary Sheet

Please complete the summary sheet below, listing the points you have claimed and the documentation provided. You must provide therequired evidence as specified in this application form and the Tier 4 Policy Guidance. All documents must be originals unless otherwise
stated. Failure to submit required evidence is likely to lead to refusal of the application.
Points Scoring Area

Points Claimed

Documents provided/held by applicant (please list)

Possession of a CAS(30 points)

Maintenance (Funds) (10 points)

Total
I confirm I have completed the separate Personal Details form and accept the contents of the declaration.
Applicant’s signature
Date

D

Parent/Legal Guardian’s signature(If applicant is 16 or 17 years old)

D

M M

Y

Y

Y

Y

D

M M

Y

Y

Y

Y

Date

D

YOU MUST SUBMIT A PAPER COPY OF THIS APPENDIX WITH YOUR SUPPORTING
DOCUMENTS. ENSURE YOU ALSO COMPLETE THE PERSONAL DETAILSFORM EITHER ON PAPER OR ON LINE. YOU SHOULD SIGN THE DECLARATION
AND SUBMIT THIS WITH YOUR OTHER DOCUMENTS.

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