studentapp by du4Gee3

VIEWS: 0 PAGES: 2

									                                          Admission Application
                                  Undergraduate Degree 2009/2010
The application form must be typed or clearly Printed and returned Admission Office

  i.   Biographical Information :              (Please write your full name as it appears on your birth
         certificate/ passport or ID) .
       Name : ………………………………………………………………………………..
                Given/First         Middle             Family/Last
       Citizenship : ……………………       Gender : …………………
       Birth date : / / 19  Place of birth : ………………………………………
                                              District City   Country
 ii. Address Information :
         Current/local address (valid to………......…… )           Address while attending University (if different)

         Street :…………………………………………...                            Street :

         District : ………………………………………                             District : ………………………………………

         City : ……………………………………………                               City : ……………………………………………

         Country : ………………………………………..                            Country : ………………………………………..

         Day – time telephone : ………………………….                     Day – time telephone : ………………………….

         Mobile : …………………………………………                              Mobile : …………………………………………

         Email : …………………………………………..                             Email : …………………………………………..

iii. Next of kin / Guardian contact information :
      Name : ………………………………………………………………………………..
      Address :
      Street : …………….………………….               City : ……………        Country :
      ……………
      Day – time telephone : ………………         Mobile : …………        Email :
      ……………….
iv. Admission Information :
      Term you are applying for     Fall (    )    Spring ( ) Summer (                                        ) Year ……..
      Faculty you are applying for  Dentistry                   (                                         )
                                    Pharmaceuticals             (                                         )
                                    Marketing & Management      (                                         )
                                    Mass Communications         (                                         )
                                    Computer Science            (                                         )
                                    Engineering                 (                                         )
 v. Secondary School Information :
       Name of school : ……………………………. Language of instruction :
       ………………………...
       City : ……………………                 Country : ……………           Email :
       ……...…………………...
       Type of Certificate : ……………………………………….                    Graduation date :
       ………………..
       (Thanaweya Amma graduates should indicate Arts  Science or Maths)
       School Type                International (         Language       (
                                  )                       )
                                  Government      (       Experimental (
                                  )                       )
vi. College/University/Post-secondary School
        University/college      Faculty          Major      City           Years



vii. Health Information :
Have you ever suffered any serious or emotional illness ? Yes ( ) No ( ) If
yes, please specify :
………………………………………………………………………………………….
.

………………………                   …………           ……………………………..
        …………
Signature of Applicant      Date           Signature of Parent/Guardian
        Date

								
To top