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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

HALL OF RESIDENCE APPLICATION FORM

ACADEMIC YEAR - 2012/2013

                                                      NEW STUDENTS

(Kindly fill out the form using BLOCK letters)

Personal Information

PLACE PHOTO

HERE

   UWI ID/Registration No. __________________________      

   SURNAME _____________________________________________

   FIRST NAME           _____________________________________________       

  HOME ADDRESS     ______________________________________________

  (including country)

   __________________________________________________________________

MAILING ADDRESS (if different from above)

______________________________________________________________________________________

GENDER:  Female /Male                                         DATE OF BIRTH:   _____________

                                                                                                                dd/mm/yy

TELEPHONE   ___________________       ___________________    E-MAIL _________________________

                          (Home)                               Mobile)       

Do you have any known medical ailments/allergies?  __________________________________

Person to be contacted in case of an emergency:

NAME __________________________ RELATIONSHIP TO APPLICANT ______________________________

ADDRESS ___________________________________________________________________________

TELEPHONE   ____________________     _______________________   ________________________________

                             (Home)                            (Mobile)                               (E-mail)

Confidential Information

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.

Academic Information

Postgraduate            Undergraduate           

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