LIPA Foundation Certificate

in Popular Music &

Music Technology
UK/EU Application Form
2017 Entry
UK/EU applicants should use this form to apply for the Foundation Certificate in Popular Music &
Music Technology

Completing this form

You can fill in this form by hand, sign, date it and return it to us with any supporting information by
post to: Admissions, The Liverpool Institute for Performing Arts, Mount Street, Liverpool L1 9HF.
Please complete section 1 in BLOCK CAPITALS and the rest in upper and lower case.
Or
You can download the form, type into it, then print it off, sign, date it and return it to us with
any supporting information by post to: Admissions, The Liverpool Institute for Performing Arts,
Mount Street, Liverpool L1 9HF.
Or
You can download the form, type in your details and type your name into the signature box and
then submit it via e-mail with any supporting information to admissions@lipa.ac.uk

Section 1 Personal Details

Please enter your name as it appears on your passport/birth certificate

Forename(s) Umairra

Surname Ul Hasan

Gender Male Female

Date of birth (dd/mm/yyyy) 2 8 / 0 2 / 1 9 9 8

Email umairra.2017@outlook.com

I am able to attend an Yes No

audition/interview in Liverpool
I would like to start in September (Year) 2 0 1 7

For office use only Admissions officer:

Attribute one Attribute two Attribute three Attribute four Attribute five Attribute six

Interview/audition: Yes No Postal audition: Yes No

Outcome: Rec Uncon Cond Rej Res

Conditions:

Signed: Date: / /

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Section 1 Personal Details (continued)
Address 470 Crocketts Lane, Birmingham, West Midlands

Postcode B16 9GD

Mobile phone number 07837561430

Telephone number (inc. dialling code) 0121 554 2070

Section 2 Areas of interest and DVD submission

Indicate 1 for your first
interest and 2 for your 2 Production 1 Performance
second
Piano, guitar, voice, trombone, flute, drums
Please list your
instruments (including
voice) with main
instrument first.

DVD To be submitted with your application.

Please clearly label your DVD with your name and the course you are applying for.
At the start of the DVD, please film yourself explaining in no more than three minutes your musical
history, career aspirations and your reasons for wanting to study at LIPA.
You should also include three tracks on the DVD. You should be filmed playing (or singing) on at least
one of the tracks so we have visual evidence of your performance ability. You are welcome to play (or
sing) either unaccompanied, with other musicians or to a backing track. The other two tracks can be
audio files. Pick the tracks that you feel showcase your musical talent best and any other relevant skills
(such as songwriting/arranging or production).

Track 1 is titled Crazy in love

My role on the track is Pianist, singer

Track 2 is titled Sweet Dreams

My role on the track is Pianist

Track 3 is titled Forgiven For Yesterday

My role on the track is My personal composition, Singer, Pianist

Please note that we are unable to return your DVD

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 Completing Sections 3 to 5
Before completing these sections, please refer to the entry requirements (pages 58-63 in our 2017
Entry Prospectus).

Section 3 Information about you that tells us about your

knowledge, experience, commitment and spirit of enterprise

Please describe the most important activities that you have undertaken which are relevant to
Popular Music and Music Technology. These may be projects and performances (within or outside
school) or work experiences (either paid or unpaid) or training or short courses. Dont be put off
if you have less than six examples. If you have more than six examples, please continue on a
separate sheet.

For each activity that you list, please follow these steps:
Step 1 Tell us the dates or duration of the activity.
Step 2 Explain your role/responsibilities in the project/performance or work experience.
Step 3 Tell us who organised it.
Step 4 Tell us where it happened.
Step 5 Tick Yes if it was part of a school/college qualification or No if it was something that
was either extra-curricular at school or college or undertaken entirely independently
of school /college.
Step 6 If it was undertaken independently of school/college, please tick Yes if you were paid
for undertaking this activity. If it was voluntary or you did not get paid, please tick No.

Activity 1

Date/Duration of activity TUESDAY 6TH DECEMBER 2016 (3 DAYS)

Description of activity,
including your
role/responsibility
I took the leadership role in ensuring that the band had gotten everything in to place in time for the
shows commencing from 06/12/16. As well as leading, I featured in nearly all of the show with
singing and playing piano. I had opportunities to play other instruments but when the shows began
their was only one pianist which was me. Therefore, I just stuck with piano and vocals. I helped out
backstage and just kept the moral high as the shows do tend to get a little repetitive.

Who organised the activity? My Band and My Tutor

Where did it take place? Theatre

Was this part of a Yes No If No, did you Yes No

school/college qualification? get paid for
this activity?

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Activity 2

Date/Duration of activity AUGUST 2016 (3 HRS)

Description of activity, I performed in all of the line ups and was in charge of the rehearsals.
including your
role/responsibility

Who organised the activity? Myself and a crew

Where did it take place? Birmingham Concert

Was this part of a Yes No If No, did you Yes No

school/college qualification? get paid for
this activity?

Activity 3

Date/Duration of activity OCTOBER 2016 (1 DAY)

Description of activity, I performed, organized and managed the cost as well as the payments made following our show. I
was also in control of our slot in the line up of artists.
including your
role/responsibility

Who organised the activity? Myself and my partner

Where did it take place? Manchester

Was this part of a Yes No If No, did you Yes No

school/college qualification? get paid for
this activity?

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Activity 4

Date/Duration of activity 10/10/16

Description of activity, I performed twice singing and playing guitar.

I wrote a mash up between Written in the Stars and Pastime Paradise
including your and managed the harmonies
role/responsibility

Who organised the activity? My tutor and the band

Where did it take place? College

Was this part of a Yes No If No, did you Yes No

school/college qualification? get paid for
this activity?

Activity 5

Date/Duration of activity DECEMBER 2013 (4 HRS)

Description of activity, I was one of the acts in the talent show and had to lead the rest of the band who were playing my
song. I came 1st place overall.
including your
role/responsibility

Who organised the activity? music dep

Where did it take place? sform

Was this part of a Yes No If No, did you Yes No

school/college qualification? get paid for
this activity?

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Activity 6

Date/Duration of activity JAN 2017 (6 HRS)

Description of activity, performing, singing, song writing, playing piano and guitar as well as trombone and drumkit.
including your
role/responsibility

Who organised the activity? Myself and My best friend

Where did it take place? Manchester

Was this part of a Yes No If No, did you Yes No

school/college qualification? get paid for
this activity?

Optional explanation text

It may be that you have been unable to take part in any extra-curricular activities. If this applies
to you, then you are welcome to fill in this aspect of the form. Leave it blank, if it does not apply
to you.

Please tell us why you

have been unable to
undertake extra-curricular
activities (e.g. the area you
live in)

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Section 4 Information that tells us about how the
discipline you are applying for will help you to grow and
achieve your career aspirations

Please state your career I aim to be better, to do better and to progress. I want to always move upwards and to constantly
challenge myself so that I am prepared for the real world. I would like to be successful, to have
aims and aspirations everything my mom didnt and to be able to take care of her and my nan and my other immediate
family. I want to have something to be proud of and that others can be proud of too.

Please identify four skills
that you expect to develop
with us to help you to
achieve your career
aspirations and explain
why these are important
to you.
Boosting my confidence skills as well as my self esteem and performance skills. Its
important that I do this in order to progress in my career but also as an individual.
1
Technical skills. I know the basics but I want to be able to play more professionally and look
back after the performance and really feel like i have achieved something

Anxiety and nerve management. I want to be able to control my nerves so that they don't
effect my performance because I don't want to have any regrets after any of my
performances.
3

Leadership skills. Being able to express my ideas and be creative with what I do makes the
process more worthwhile. I enjoy seeing my hard work pay off and appreciated by the
audience as well as the band. Being able to connect with the audience is one of the most
4 vital skills in any performers career.

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What was it about us that I enjoy performing, song writing and unleashing my creativity because it is where I belong and its
what I would like to do long term. I know that by working with you I will be able to develop further in
attracted you to apply here? my career and push myself more than ever before.

What is the most
memorable piece of
advice you have followed
so far and why was it
helpful?
Be yourself. Trust yourself and believe and love yourself because if you don't how do you expect
others to?- This advice is always cherished because it's all true and I wouldn't be moving any
closer to my goals if I remain my own worst enemy and limit myself out of fear or lack of
confidence/ disbelief in myself.

Section 5 Information about you that tells us about your

broad interest and engagement

We want to prepare you for sustained work. We want to know that you have some
understanding about the world of work that you will be entering, so we can develop this.

Please name at least two
Political, Economic, Social
or Technological factors
that might affect your
work when you graduate
and why.
1. My background may affect me because I'm not the stereotypical person that would be classed
as a musician. I am my own person and I am unique, I have strengths and weaknesses and some
people would see that as a disadvantage.
2. Anxiety and low self-esteem. I may just focus on how good everyone else is and not give myself
the chance to progress out of fear of not making it/ making a fool out of myself

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Section 6 Education
Qualifications - already completed
Please list details of qualifications that you have completed at school, college or university starting
with the most recent first.

Name and address of Subject Level of Date you Grade/mark/

school or college qualification received result band awarded
GDA MATHS GCSE JUNE 2014 C

ENGLISH LIT B

ENGLISH LANG C

STATISTICS C

I.T C

RELIGIOUS ETHICS B

MUSIC A+C

MANAGEMENT B

FRENCH B

HISTORY C

CHEMISTRY C

BIOLOGY B

PHYSICS D

Qualifications you are currently undertaking - not yet completed

Please list details of qualifications and examinations to be taken prior to September 2017 (if any/if
appropriate).

Name and address of Subject Level of Date you expect Predicted

school or college qualification to receive your grade/mark
results
SANDWELL COLLEGE Music L3 LEVEL 3 JUNE 2017 Distinction

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Section 7 Declaration

I understand that if I have knowingly supplied false information on

this application that I am liable for immediate exclusion. (Please tick box)

I confirm that to the best of my knowledge, the information on this

form is correct and complete. (Please tick box)

LIPA is registered under the Data Protection Act 1998 and information given on this form will
only be used in accordance with the terms of LIPAs registration.

I give my explicit consent to the processing of my data by LIPA. (Please tick box)

I have read, understand and abide by the terms and conditions. (Please tick box)

Signed: UMAIRRA.H Date: 2 4 / 0 2 / 2 0 1 7

Please send your completed application form with supporting information to:
Admissions, The Liverpool Institute for Performing Arts, Mount Street, Liverpool L1 9HF.
Or
email it with supporting information to admissions@lipa.ac.uk

Please remember to pay the correct postage!

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Section 8 Monitoring Information

We are asking you for the following information because we want to welcome people from a
wide range of backgrounds.
UK law also says that we need to make sure we treat people fairly and equally. We need to know
who is applying to ensure that they have a good experience from us and we know who else we
need to encourage to join us. Information provided here is not used in any selection procedure
and remains confidential to our administration team.

Please tick the box which best describes your ethnic origin. How did you hear about LIPA?
Arab Please tick the two main reasons out of the following list
which have helped to influence your decision to apply to LIPA:
Asian or Asian British Bangladeshi
LIPA prospectus
Asian or Asian British Indian
LIPA website
Asian or Asian British Pakistani
UCAS website
Black or Black British African
Coverage in the media
Black or Black British Caribbean
Teacher/tutor
Chinese
Careers Adviser
Gypsy or Traveller
Advertisement
Irish Traveller

Attendance at LIPA Open Day

Mixed White and Asian
Facebook
Mixed White and Black African
Twitter
Mixed White and Black Caribbean
Attendance at CDET Careers Fair
Other Asian Background
Attendance at Compose Your Future
Other Black Background
Attendance at Design Your Future
Other Ethnic Background
Attendance at Move It and Perform
Other Mixed Background
Attendance at Theatre Craft
Other White Background
Attendance at another exhibition or careers fair
White
The British Council
White Scottish
Recommendation from another LIPA student/graduate
Other Please detail:
Disability
Please tick the box which best describes your status with
respect to any disability and/or health condition expected to
last 12 months or longer.
No known disability
A long standing illness or health condition such as
cancer, HIV, diabetes, chronic heart disease or epilepsy
A mental health condition, such as depression,
schizophrenia or anxiety disorder
A physical impairment or mobility issues, such as
difficulty using arms or using a wheelchair or crutches
A specific learning difficulty such as dyslexia, dyspraxia
or AD(H)D
Autistic Spectrum Disorder
A social/communication impairment such as Aspergers
syndrome/other autistic spectrum disorder
Blind or a serious visual impairment uncorrected by
glasses
Deaf or a serious hearing impairment
Two or more impairments and/or disabling medical
conditions Thank you for completing this monitoring form.
If you have any concerns about the information
A disability, impairment or medical condition that is not
listed above
requested, please contact the Admissions Manager
on +44(0)151 330 3000.

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Terms and Conditions

The LIPA prospectus was printed in spring of 2016. It contains information on the courses that The
Liverpool Institute for Performing Arts intends to run for students who are planning to start university in
the autumn of 2017. The more detailed website content for courses has been created in summer 2016. LIPA
has made every effort to ensure that information provided is both helpful and accurate as at the date of
publication. However, some changes, for example to courses, facilities or fees may become necessary due to
legitimate staffing, financial, regulatory and learning reasons. LIPA will endeavour at all times to keep any
changes to a minimum and to keep students informed appropriately. For this reason, it is particularly
important that you check the website for updates or contact the Admissions Team at LIPA (email
admissions@lipa.ac.uk, tel: 0151 330 3000).

Abiding by our rules and regulations

A condition of enrolment is that you abide by, and submit to, our rules and regulations as contained in
our student handbook. These rules and regulations are subject to amendment from time to time.
Extracts from the current Student Handbook can be obtained on request from our Admissions Department.

Payment of fees
Tuition fees are, in general, due for payment in full by the student two weeks before enrolment. First year
international degree course students and all Foundation Certificate course students are required to pay a
deposit amounting to 25% of the first years fee no later than 31 May.
UK and EU students who do not take up their Student Loan entitlements are required to pay their fees in
full two weeks before enrolment.
Students in receipt of UK or overseas Government loans, US Federal Financial Aid, Professional and Career
Development Loans, private loans or sponsorship from a recognised source, may pay their fees in
accordance with the terms of the receipt of their funding arrangements. Written confirmation of this
funding must be provided on or before enrolment.
Other students who cannot or do not access the public funding sources available to them may pay their
fees in two equal instalments only if they provide a letter of guarantee from a party acceptable to the
Institute. The first instalment must be paid a full two weeks before enrolment.
Fees are only payable online by debit or credit card.

Withdrawals
We reserve the right to retain up to 50% of any deposit paid where a withdrawal of acceptance of an offer
is received after 31 July in the year of entry. Students who are receiving US Federal Financial Aid will be
refunded as per US Department of Education R2T4 regulations.
First year and Foundation Certificate students are allowed a four week cooling off period from the date of
enrolment in which to decide if they wish to continue with their studies or withdraw from their course. In
the event of a student withdrawing within the first four weeks they will be charged only an administration
fee which is currently 100.
Full-time undergraduate and Foundation Certificate students withdrawing after the cooling off period
will be charged an administration fee, currently 100 plus a proportion of the fee payable by the student
calculated on a pro-rata basis on the number of weeks of study undertaken, commencing from the date
of enrolment.
For students in receipt of a SLC tuition fee loan we will restrict the amount we require you to pay to us to
the amount the SLC will loan you.
Students from outside the European Economic Area who require a student visa, should note that the
Institute is obliged to notify UKVI if a student has multiple unauthorised absences, fails to enrol on their
course or terminates their studies.

Please retain a copy of these terms and conditions for your records.

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