Expression of Interest

International Programme in Addiction Studies

Master of Science in Addiction Studies
Graduate Certificate Programmes in International Addiction Studies

Complete the following online expression of interest form in order to provide your contact information to programme faculty at VCU, KCL and University of Adelaide so that we may provide you additional information if you request it.  If you wish to upload a CV and personal statement of interest, you may do so.  Note that this is not a part of the formal programme application process.



Semester and year of entry (Check only one)



Program of Interest?

Applying for:

Present Residential Address
(including Country and area code)

Present Postal Address (if different)

Standardised Testing:

Test Date Taken Score
TOEFL( Test of English as a Foreign Language)
IELTS (INT English Language Testing Service
GRE (Graduate Record Examination-Aptitude)
Other Test (Please Identify )

Note: Only information on TOELF or IELTS scores is mandatory, and then only for students from a country where English is not the first language or who have not successfully completed a degree studied in the English language.

Educational Background
Name and location of Institution (city and country) Academic level Dates of Attendance ( from month/year to month/year completed) Major field of study and Grade point average/grade point average scale (e.g, 3.2/4.0;8/10) or classification (pass, distinction) where applicable Degree, certificate or diploma awarded and date awarded or to be awarded.

Academic references:

List the names, addresses and positions of three persons, preferably professors, supervisors, or professionals, who are completing reference forms for you. At least one reference must be from an institute of Higher Education

A: Name, Position and Address
B: Name, Position and Address
C: Name, Position and Address

Ethnic origin (please tick one of the following options)
Note: Providing information on ethnic background is not compulsory

Aboriginal and/or Torres Strait Islander


Asian or Asian British

Other Asian Background


Black African

Black Caribbean

Other black background


Hispanic or Latino


Other Indian background


Native Hawaiian or other Pacific Islander

Native American or Alaskan Native

Mixed (White and Black Caribbean)

Mixed (White and Black African)

Mixed (White and Asian)



White/Caucasian (British)

White/Caucasian (Irish)

White/Caucasian (other)

Other background not listed:

How did you first hear about our programme?

What influenced you to apply ?

Personal Statement

On a separate sheet, please write a personal statement in which you discuss the following: your reasons for seeking to obtain this degree, including your career goals and how you envision that the programme will help you meet those goals; prior life/work experiences that relate to your interest in and aptitude for the programme; and your perception or your capacity to complete the programme successfully.