THE UNIVERSITY OF THE WEST INDIES
ST. AUGUSTINE, TRINIDAD AND TOBAGO, WEST INDIES
STUDENT ADVISORY SERVICES
Telephone: (868) 662 2002 Ext.82096/82097; 82325 Fax: 663 0052
(Kindly fill out the form using BLOCK letters)
UWI ID/Registration No. __________________________
FIRST NAME _____________________________________________
HOME ADDRESS ______________________________________________
MAILING ADDRESS (if different from above)
GENDER: Female /Male DATE OF BIRTH: _____________
TELEPHONE ___________________ ___________________ E-MAIL _________________________
Do you have any known medical ailments/allergies? __________________________________
Person to be contacted in case of an emergency:
NAME __________________________ RELATIONSHIP TO APPLICANT ______________________________
TELEPHONE ____________________ _______________________ ________________________________
(Home) (Mobile) (E-mail)
Have you ever been convicted of or pleaded guilty or no contest to any criminal offense? ________
Have you ever been suspended or expelled from your previous school/academic institution? _____
If yes, to either of the questions above, kindly attach the appropriate documentation and a full statement of the relevant facts from the court that adjudicated the charges or the school from which you were expelled or suspended.
If no, kindly attach a police certificate of good character or a letter of recommendation from an academic institution you attend/attended or from a person of good standing in your community, who is familiar with you.
This documentation would be handled confidentially. The University of the West Indies reserves the right to determine who is permitted to stay on hall based on the information given. This is to ensure that the safety and welfare of the students are not jeopardized and that the applicant is eligible for on-campus accommodation.