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  • 8/14/2019 Dubai Application Form

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    YOU MUST INFORM HERIOT-WATT UNIVERSITY OF ANY CHANGE IN YOUR PERSONAL DETAILS

    REGISTRATION/MATRICULATION NO:(For University use)

    Application Reerence No(For University use)

    Code Accepted Conditional Pending RejectedCreditsAccumulated

    Modulesrequired

    Universityuse only

    Application or Study at Heriot-Watt University Dubai CampusPLEASE USE CAPITAL LETTERS ONLY

    Section A TO bE COmPLETEd bY ALL APPLICANTS

    Please reer to the enclosed Application Guidelines beore completing this application and ensure that your application processingee o AED 200 is included when you submit this to the Campus.

    PROPOSEd PROGRAmmE

    Course Title

    Undergraduate Study Postgraduate Study Start Date (please check available dates) MM/YY

    Method o study (please check whether a part-time option is available or your chosen course) Full-time Part-time

    PERSONAL dETAILS

    Title (Dr/Mr/Miss/Mrs/Ms/Other)

    Please afx a currentcolour passport

    photograph. This

    must be on a whitebackground

    Please ensure thatyour reeree signsthe Certifcate O

    Authenticity in section Do this Application Form

    First Name(s)

    Surname/Family Name/Last Name

    Date o Birth (DD/MM/YYYY)* N.B. Kindly note that you must be under 25 years o age when you completeyour undergraduate degree with us due to visa rules

    Sex (Male/Female)

    Marital Status (Married/Single/Divorced/Separated)

    Permanent Address Correspondence Address in UAE (i dierent)

    Residence Tel No: Residence Tel No:

    Ofce Tel No: Ofce Tel No:

    Mobile No: Mobile No:

    Fax No: Fax No:

    Email Address: Email Address:

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    YOU MUST INFORM HERIOT-WATT UNIVERSITY OF ANY CHANGE IN YOUR PERSONAL DETAILS

    Nationality Country o Birth Country o PermanentResidence

    Country o Current Residence

    Passport No. Date o Issue (DD/MM/YYYY)

    Date o Expiry (DD/MM/YYYY)

    ETHNICITY

    Ethnicity Code* * See Application Guidelines

    VISA dETAILS

    Do you hold a valid UAE Residence Visa? No Yes (please provide details below)

    Visa No. Visa Type

    Date o Issue (DD/MM/YYYY) Date o Expiry (DD/MM/YYYY)

    LEVEL OF ATTAINmENT IN ENGLISH

    I English is not your frst language please speciy in the space below the standard you have attained. (eg GCSE orTOEFL or IELTS)

    Formal Qualifcations(eg GCSE or TOEFL or IELTS)

    Grade Date Other experience o using the English Language(Please give details)

    SPECIAL NEEdS

    Please give details o any physical or other disabilities (I none please write None)

    Disability Code* * See Application Guidelines

    Section b TO bE COmPLETEd bY APPLICANTS FOR UNdERGRAdUATE STUdY ONLY

    EdUCATION FROm AGE 16Please enter the name & address o each school and college and include the institution you are presently attending.

    School/College FromMonth Year

    ToMonth Year

    Mode o Study*PT; FT; DL

    * PT = Part-Time; FT = Full-Time; DL = Distance Learning

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    YOU MUST INFORM HERIOT-WATT UNIVERSITY OF ANY CHANGE IN YOUR PERSONAL DETAILS

    RECENT EmPLOYmENT

    Please enter present and previous employment (i any) starting with the most recent.

    Employer Nature o Work FromMonth Year

    ToMonth Year

    ACAdEmIC QUALIFICATIONS

    Please enter examinations or assessments or which results are known. List all subjects taken, including ailures, inorder o the most recent result frst. Group together subjects taken at one sitting. Verife Copies o Certifcatesan Acaeic Transcripts ust e provie. Without these, your application will not be considered.

    Examining Body ExamDate

    Subject Level Result

    Please enter examinations or assessments to e coplete or results pening

    Examining Body ExamDate

    Subject Level ResultExpected

    Section C TO bE COmPLETEd bY APPLICANTS FOR POSTGRAdUATE STUdY ONLY

    FINANCIAL dETAILS

    Please give details o any grant/scholarship which has already been awarded to you or your proposed study

    Please give details o any application or a grant which you have made or would wish to make

    Please note that you may be asked to provide documentary evidence o how you are unding your studies.

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    YOU MUST INFORM HERIOT-WATT UNIVERSITY OF ANY CHANGE IN YOUR PERSONAL DETAILS

    PREVIOUS ACAdEmIC & PROFESSIONAL INFORmATION

    Please give details o all Degrees / Diplomas / Other Qualifcations

    Name o University/College/Institution

    From To Title oQualifcation

    Class oDegree

    Date Awarded Date to beAwarded

    Please give details o subjects studied or the above qualifcations which are relevant to your proposed course o study.In addition, please give the title o any dissertation or project undertaken. Please continue on a separate sheet inecessary.

    Please give details o any other inormation, including work experience, which is important to your application. Forsome courses work experience is essential. Please state whether work was ull-time or part-time and give dates, jobtitles and principal responsibilities. Please continue on a separate sheet i necessary.

    Please indicate your current position in employment or training. You may also give an indication o why you areinterested in your chosen course o study. Please continue on a separate sheet i necessary.

    EmPLOYmENT HISTORYPlease enter present and any previous employment starting with the most recent. Please continue on a separate

    sheet i necessary.

    Employer Nature o Work/ Key responsibilities FromMonth Year

    ToMonth Year

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    YOU MUST INFORM HERIOT-WATT UNIVERSITY OF ANY CHANGE IN YOUR PERSONAL DETAILS

    Section d to e coplete y all applicants

    REFERENCES

    Please provide ull contact details o two reerees. One o your reerees should sign the certifcate o authenticitybelow. For guidance on the two reerences which should accompany this application, please reer to the ApplicationGuidelines.

    Name o Reeree Name o Reeree

    Organisation/Post/Occupation/Relationship Organisation/Post/Occupation/Relationship

    Address Address

    Mobile No Mobile No

    Telephone No Telephone No

    Email Address Email Address

    Certifcate o Authenticity

    I certiy that the photograph attached to this Application Form is a true likeness o the applicant

    Signature__________________________________________________________________ Date _______________________________

    Name

    FURTHER INFORmATION

    Have either o your parents studied at a University? Please tick. One Both Neither

    I agree that my employer or sponsor may receive inormation about me Yes No

    I agree that a reerence may be provided to a potential employer Yes No

    I agree that inormation may be passed to the UK Joint Inormation SystemsCommittee to allow me to participate in use o JISC sotware or my studies

    Yes No

    I agree that my photograph may be used or promotional purposes (Note thatrecordings o Graduation ceremonies include coverage o all students attending)

    Yes No

    Inormation in support o your application, such as details o responsibilities held, voluntary work, memberships osocieties and other interests such as reading and sports may be given below

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    YOU MUST INFORM HERIOT-WATT UNIVERSITY OF ANY CHANGE IN YOUR PERSONAL DETAILS

    INTROdUCTION dETAILS

    What was the main source o inormation which led you to fnd out more about study at Heriot-Watt University?Please tic one ox only.

    Your teachers World Wide Web

    Careers service www.hw.ac.uk

    Friends or amily www.hw.ac.uk/dubai

    Current Heriot-Watt student or alumnus Education guide

    Recruitment air or school air Advertisement (state radio, press)

    Recruitment agent Employer/HR department

    Word o mouth Proessional association

    Open day on campus in Dubai Please State

    Are you a member o sta at Heriot-Watt University? YES NO

    Are you the spouse or child o a member o sta at Heriot-Watt University? YES NO

    I the answer to the above is yes, state the name o the sta member

    dECLARATION: (To e signe y the applicant)

    1 I confrm that to the best o my knowledge the inormation given in this orm is correct.

    2 I understand that a Matriculated student is required to abide by the regulations o Heriot-Watt University andconorm with its Policies, Procedures, Ordinances and Regulations.

    3 I accept liability or payment o tuition ees in the absence o an awarding body.

    4 I agree that Heriot-Watt University may use my personal data in accordance with the University DataProtection Policy and UK Data Protection Act 1998. I agree that Heriot-Watt University may use my personaldata in accordance with the University Data Protection Policy, the UK Data Protection Act 1998 and otherapplicable data protection law.

    5 I understand that in processing my application to study at Heriot-Watt University Dubai, Heriot-WattUniversity is also required to share personal inormation which it holds about me with the Dubai Technology,Electronic Commerce and Media Free Zone Authority.

    6 The inormation held by Heriot-Watt University about me may be obtained rom various sources, includingdirectly rom me and rom my dealings with Heriot-Watt University. It will be used by the Dubai Technology,Electronic Commerce and Media Free Zone Authority to oversee the admission o students, to assessacademic perormance, to regulate and oversee the operation and administration o academic courses at theDubai Knowledge Village by Heriot-Watt University and, where applicable, to process visa applications madeby me or study on Heriot-Watt University Dubai Campus courses.

    7 I agree that Heriot-Watt University may transer my personal data to the Dubai Technology, ElectronicCommerce and Media Free Zone Authority.

    8 Heriot-Watt University Dubai Campus will use all reasonable endeavours to deliver courses and programmes

    o study as inormed to the students. It is possible, however, that some changes may occur and the Universityreserves the right to make variations to the content or method o delivery o courses, to discontinue orcombine courses, and to introduce new courses i at any time such action is considered to be reasonable andnecessary.

    9 I confrm that I have read and understood the terms and conditions governing the programme and eestructure. I hereby apply or enrolment and i accepted, I agree to comply with the standard rules, regulationsand ordinances o Heriot-Watt University generally and Heriot-Watt University Dubai Campus specifcally. I Ido not comply with any o the rules o the University, the University has the right to take disciplinary actionagainst me.

    Signature__________________________________________________________________ Date _______________________________

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    YOU MUST INFORM HERIOT-WATT UNIVERSITY OF ANY CHANGE IN YOUR PERSONAL DETAILS

    CHECkLIST: For UAE ase stuents i.e.

    StudentswhodonotrequiretheUniversitysvisasponsorshipor Studentswhoarecurrentlyontheirfathers/motherssponsorshipor StudentswhoholdavalidUAEemployment/residencevisa

    Have you answered all questions?

    Have you provided proo o English language profciency?

    Originals or certifed copies o academic transcripts, grading systems including certifed translation i not in English

    Two Reerences (see Application Guidelines)

    Proo o work experience/C.V. (i applicable)

    Copies o any papers published (applicable or post-graduate applicants)

    Details o any fnancial awards (applicable to post-graduate applicants)

    1 Certifed copy o passport and UAE residence visa (i applicable)

    Four (4) passport sized colour photographs (with white background)

    Read the application orm and signed the declaration?

    CHECkLIST: For Stuents requiring the Universitys visa sponsorship i.e.

    StudentsfromoutsidetheUAE StudentsintheUAEonavisitvisaor StudentsonavalidUAEresidencevisawantingtheUniversitytosponsortheirvisa

    Have you answered all questions?

    Have you provided proo o English language profciency?

    Originals or certifed copies o academic transcripts, grading systems including certifed translation i not in English

    Two Reerences (see Application Guidelines)

    Proo o work experience/C.V. (i applicable)

    Copies o any papers published (applicable or post-graduate applicants)

    Details o any fnancial awards (applicable to post-graduate applicants)

    3 Certifed copies o passport and UAE residence visa (i applicable)

    Twelve (12) passport sized colour photographs (with white background)

    Read and signed the Student Enrolment Contract

    Recent bank statement o the students account showing unds equivalent to UAE Dirham 30000 (approximatelyUS$8300). I the account is not in the name o the student, then the account holder should also send a letter statingthat he/she is sponsoring the students education.

    Read the application orm and signed the declaration?

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    YOU MUST INFORM HERIOT-WATT UNIVERSITY OF ANY CHANGE IN YOUR PERSONAL DETAILS

    FOR UNIVERSITY USE:

    CONdITIONS TO bE mET bY STUdENT bEFORE ENTRY (please tic as appropriate)

    A Need or urther study. Please speciy

    B Need or Completion o present course. State minimum award or entry.

    C Proo o English ability D Evidence o previous academic attainment

    E Need or urther reerences. Please speciy rom whom.

    Any others. (Please provide detail)

    RECOmmENdATION (please tic as appropriate)

    I recommend that the application be

    Accepted

    Accepted on the conditions specifed above

    Not accepted

    Head o School or Authorised Signatory

    Signature__________________________________________________________________ Date _______________________________

    Please return this orm to:

    Admissions Ofce

    Heriot-Watt University Dubai CampusDubai International Academic City

    P.O.Box 294345Dubai, UAE

    Tel: +971 4 361 6999Fax: +971 4 360 4818

    Email: [email protected]: www.hw.ac.uk/dubai

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    Application Guidelines and Fees Structure

    The sta and existing students at the Dubai Campus o Heriot-Watt University are looking orward to welcoming you to one o ourprogrammes. To ensure that your application can be processed as quickly as possible, please read the guidelines below, as well asthe notes on the application orm itsel. Sta at the Admissions Ofce will o course also be happy to help you. See our website orcontact details. www.hw.ac.uk/dubai/admissions/points-o-contact.htm

    Guidance Notes on Completing this Form1. AllapplicantsmustcompleteSectionAandSectionDandensureyourapplicationisclearandlegible.

    Ifyouareapplyingforanundergraduatedegree(e.g.BEng/BSc/BA/BBA)youmustalsocompleteSectionB.

    Ifyouareapplyingforapostgraduatedegree(MSc/PGDip)youmustalsocompleteSectionC.

    2. You must provide ofcial documentary proo o degrees, diplomas and other qualifcations. These documents must either beoriginals(whichwillbereturnedtoyouinduecourse)orveriedcopies.

    3. PleasenotethatduetoUAEvisaregulations,undergraduatestudentsmustbeunder25yearsofagewhentheycompletetheir studies.

    4. Undergraduatestudentsmustprovidetwoacademicreferences.Postgraduatestudentsshouldalsotrytoprovidetwoacademicreferences.Ifthisisnotpossible(forexampleifyouhavebeenoutofeducationformorethanthreeyears)youmay provide two work-related reerences as an alternative.

    Reerees must be

    ontheheadedpaperoftheinstitutionwithanofcialstamp

    statethenameofthecompany/institutiontowhichtherefereeisafliatedaswellastheirpositionandrelationshiptotheapplicant

    attesttotheacademicabilityofthestudentandtheirgeneralcharacterandsuitabilityforthecourse

    Ethnicity Codes Disability Codes

    To be used or completion o Section A o the Application Form.

    10 White 00 No disability

    21 BlackorBlackBritishCaribbean 01 Dyslexia

    22 BlackorBlackBritishAfrican 02 Blind/Partiallysighted

    29 OtherBlackbackground 03 Deaf/Hearingimpediment

    31 AsianorAsianBritishIndian 04 WheelchairUser/Mobilitydifculties

    32 AsianorAsianBritishPakistani 05 P ersonalcaresupport

    33 AsianorAsianBritishBangladeshi 06 Mentalhealthdifculties

    34 Chinese 07 Anunseendisability(e.g.diabetes,epilepsy,asthma)

    39 Other Asian background 08 Multipledisabilities

    41 MixedWhiteandBlackCaribbean 09 A disability not listed above

    42 MixedWhiteandBlackAfrican 99 Not known

    43 MixedWhiteandAsian

    49 OtherMixedbackground

    79 Arab

    80 OtherEthnicbackground

    90 Not known

    98 Informationrefused

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    Reerences

    How to write a Reerence?

    The person who writes a reerence or you should know you well enough to write about you. Reerences rom amily, other relativesorfriendsarenotaccepted.Ifyouareatschoolorcollege,orhaveonlyleftrecently,youshouldaskyourheadteacher,principaloran appropriate teacher or tutor to write this.

    Guidance or Reerees:

    Wewouldappreciateifyoucoulduseyourletterheadedpaper.Pleasegiveanassessmentofthesuitabilityoftheapplicantforthe

    higher education courses they have applied or and where possible, including the ollowing points:

    Existingachievement,withparticularreferencetosubjectsrelatingtothecoursesforwhichtheyhaveapplied

    Acadmicpotential,includingpredictedresultsorperformance

    Motivationandcommitmenttowardsthechosencourse

    Anyrelevantskillsachievement,whethercertiedornot

    Powersofanalysisandindependentthought

    Anyadditionalfactorswhichmayhaveaffected,orwillaffectinthefuture,theirperformance

    Informationaboutanyspecialneedsandotherrequirements

    General Guidance1 Youmustcompletetheapplicationform(thiscanbedownloadedfromourwebsite)andsendittotheAdmissionsOfceof

    Heriot-WattUniversityDubaiCampuseitherdirectly,orthroughanauthorisedagent,orthroughEikon,ourInfrastructureProvider.Pleaseensurethatallrequiredsectionsarecompleted.Theapplicationformmaybesenteitherbyregularpost,bycourier, or delivered in person. Unortunately, we are unable to accept completed aplications via e-mail

    2 Pleaseensurethatyouhaveenclosedalltherequireddocuments(seechecklistgivenintheapplicationform)alongwiththeapplicationformitself.Incompleteapplicationswillbereturnedtoyou.OnlyfullycompleteapplicationsanddocumentationsetswillbeforwardedtoHeriot-WattUniversityinEdinburghforconsideration.Fulldetailsofallrequirementsaresetoutinthe orm itsel.

    3 YouwillbeaskedtopayanadministrationchargeofAED200tocoverthecostsofprocessingyourapplication.Applicationssent without ee will not be processed. You will need to meet any bank charges incurred or any ees paid through creditcard,bank/telegraphictransferetc.inadditiontothefeeitself.YoumustalsosendacopyofthefundsTelegraphicTransferIssuingAdvice,alongwiththeapplicationform,tohelpidentifyyourpayment.Pleasecheckwithyourbankwhentransferringthefundsfordetails.IfyouareapplyingforanundergraduatecourseofstudyyouwillalsobeaskedtopayarefundablesecuritydepositofAED1000.

    4 You must fll separate application orms, and pay separate application ees, or each individual course you wish to apply or.You can pay either in cash or by cheque made payable to Heriot-Watt University or by bank transer to:

    Bank LloydsTSBPlc,POBox3766,Dubai,UAE GBPAccountNo 60601571322302

    Account Name Heriot-Watt University US $ Account No 60601571322301

    SWIFTCode LOYDAEAD AEDAccountNo 60601571322303

    5 Adecisiononyourapplicationwillbecommunicatedtoyouassoonaspossible.Ifyouareaccepted,anofferofaplaceofstudy will be made and you will be invited to accept this oer by returning the relevant acceptance orm.

    6 Insomecasesanoffermaybeconditional.Wherethisisthecaseyouwillbeinformedofanyadditionalrequirementsbeforeanunconditionaloffercanbemade.InthiscasepleaseliaisecloselywiththeAdmissionsstafftoensurethatallconditionscan be lited as quickly as possible.

    7 Onyouracceptanceoftheoffer,youwillberequiredtopaythetuitionfees.Internationalstudentswillberequiredtopaythefulltuitionfeefortheacademicyearinadvance.However,ifyouarebasedintheUAEaninstalmentpaymentplanisavailableallowing you to pay 10% o the annual ees ollowed by 9 equal instalments, supported by post dated cheques. The 10%annualtuitionfeemustbepaidwithin2weeksfromthedateofoffer.(Formoredetailsofthepaymentoptions,pleaseseethesectiononFeesbelow)

    8 Incaseachequeisdishonoured,youwillbeliabletopayaneofAED500inadditiontoanypenaltychargesyourbank(s)may levy.

    9 IfyouwishtousethetransportandaccommodationfacilitiesprovidedbytheUniversitypleasecompletethetransportationrequest orm and the accommodation request orm and submit it to Heriot-Watt University Dubai Campus at least threeweekspriortothestartofthecourse.ProvidingtransportandaccommodationfacilitiesisatthediscretionofHeriot-WattUniversity Dubai Campus management, and these services will be made available only i ound easible.

    10 You must pay Transport ees every semester and Student Accommodation ees in ull or the whole academic year in advance(seebelow).

    11 StaffattheHeriot-WattUniversityDubaiCampuswillprocessyourvisaapplicationandinformyouonreceivingthevisa.Itisimportant to inorm the University o your arrival details at least 10 days in advance. Your visa will then be deposited at yourairport o arrival.

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    Fees Structure - Academic Year 2008-09.

    Course Title Qualifcation Full Time Annual Fee (AED)

    EngineeringandPhysicalSciences/ManagementandLanguages

    DegreeEntryProgramme 24,000

    EngineeringandPhysicalSciences

    MechanicalEngineering BEngHons 43,000

    ElectronicandElectricalEngineering BEngHons 43,000EngineeringandManagement BScHons 43,000

    Energy MSc 58,000

    ManagementandLanguages

    StrategicProjectManagement MSc 58,000

    Accountancy & Finance MA/BA 39,500

    Business&Finance MA/BA 39,500

    Management MA/BA 39,500

    BusinessAdministration BBAHons 39,500

    MathematicalandComputerSciences

    InformationTechnology MSc 55,000BuiltEnvironment

    ConstructionManagement BSc(Hons) 43,000

    Quantity Surveying BSc(Hons) 43,000

    ConstructionManagement MSc 58,000

    FacilitiesManagement MSc 58,000

    Quantity Surveying MSc 58,000

    PetroleumEngineering

    PetroleumEngineering MSc 94,500

    EdinburghBusinessSchool

    MBA* MBA 8300permoduleoncampusplusGBP100exam

    AllfeesaregiveninAED.ForpaymentsineitherUS$orUKPoundSterling,pleaseasktheAdmissionsstaff.

    *Percourseoncampus.7corecoursesandaminimumof2electives.ThespecialistMBAoptionsrequireaminimumoffourelectivecoursestobestudied.From2007/8atleast2ofthe25electivecourseswillalsobeavailableoncampusandthefeeforthesewillbethesameasforcorecourses.AnexamfeeofUKPoundSterling100percourseisalsoapplicableforMBAstudents.

    Note: Students, who are made an oer o a place rom Heriot-Watt University Dubai campus, need to pay the frst installment otheirfees(equivalentto10%oftherstyearfee)atthetimeofacceptingtheofferinordertosecureaplaceonthecourse.

    Other Fees

    Student Accommodation Fees

    TheStudentAccommodationfeesareAED26,000perstudentperacademicyear,subjecttoavailability.Accommodationisprovided in ully-urnished apartments on a sharing basis. There are separate apartments or male and emale students.

    Student Accommodation

    Service Type Fee

    Singleroom(twinsharingbasis) AED26,000peryear

    Securitydeposit(refundable) AED2000

    Fees include:

    Fully-furnishedaccommodationonatwin-sharingbasisincentrallyair-conditionedrooms.

    Housekeepingservicesthreetimesweekly

    Fees do not include:

    Mealservices

    InternetfacilityattheStudentAccommodation(availableonacostbasis)

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    There are a limited number o spaces available and bookings are confrmed only when we receive the completed AccommodationApplication Form, ull payment o accommodation ees and ull payment o the relevant tuition ees. All o these payments must bereceived at least 30 days beore your course begins. There is no reund or early departure rom the Residences or any reason. Thesecuritydepositisrefundableattheendoftheprogramafterdeductiontowardsdamages/lossofitems,ifany,causedbystudent.)

    Student Transport

    Transportisavailableforbothsemestersperyear,subjecttoaminimumnumberofstudentsandonlyiffoundfeasible.Transportees are payable or the entire year in two instalments. The frst instalment should be paid 30 days beore the start o the courseand the second instalment should be paid as a post-dated cheque, 30 days prior to the start o the second semester. Regrettably

    transport ees are non-reundable.

    Transport Fees

    Journey starts Fee

    BurDubai,Deira,Karama AED4200peryear

    GhusaisandSharjah AED6000peryear

    Abu Dhabi AED7800peryear

    Visa Fees

    The ees or visa sponsorship are as ollows:

    Service Type Amount (in AED)StudentResidenceVisa(outsideUAE) AED2500(PerYear)

    StudentResidenceVisa(inCountry) AED4500

    DepositforVisaSponsorship(Refundable) AED2500(Once)

    Student Visa Renewal AED2500(PerYear)

    VisaCancellationfees(withoriginalpassport) AED600

    VisaCancellation(outofUAEw/opassportandID) AED2200

    Service Letters or students AED120

    RTA Letters AED220

    VisafeesarebeyondthecontroloftheUniversityandaresubjecttochange.Incaseofanincreaseinthevisachargesbythe

    governmentauthorities,thestudentwillbeliabletopaytheadditionalvisacharge(s).Visafeesoncepaidarenon-refundableunderany circumstances. For details on Visa sponsorship ees please reer to Student Visa policy document.

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    Application Reerence No(For University Use)

    Application or Study at Heriot-Watt University Dubai Campus

    PLEASE USE CAPITAL LETTERS ONLY

    Photograph Form

    Please note that the inormation submitted below will be used to produce your student ID card so you must ensurethat the name used is stated correctly and as it appears in your passport

    First Name(s)

    Please afx a currentcolour passport

    photograph here.

    Surname/Family Name/Last Name

    Date o Birth

    Day Month Year

    The photograph must have a WHITE background. Do not use staples. You may use clear sticky tape

    PLEASE SIGN THIS FORM AND SUBMIT THIS WITH YOUR APPLICATION

    Signature__________________________________________________________________ Date _______________________________