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THE UNIVERSITY OF THE WEST INDIES

APPLICATION FOR FIRST DEGREE, ASSOCIATE DEGREE, DIPLOMA AND CERTIFICATE PROGRAMMES

The accompanying Instruction sheet provides detailed information on the completion of this application form. All applicants are urged to read this information carefully. The Associate Degree is offered only through the School of Continuing Studies.

SECTION A – PERSONAL DATA

1. Name Title

Last Name/Surname

First Name

Middle Name(s)

2. a) Former Name (if applicable)

Title

Last Name/Surname

First Name

Middle Name(s)

b)

Type of Former Name:

Maiden

(Prior to) Deed Poll

3. Have you previously applied to the UWI?

5. If answer to question 4 is yes, please state the following:

Yes

No

a) Identification Number

b) From (year)

c) To (year)

d) Campus

4. Have you previously been a student at the UWI?

e) Programme

Yes

No

6. a)

Permanent Address: Apt/Street/PO Box

7. a)

Mailing Address (if different from 6): Apt/Street/PO Box

City/Town/Post Office

Parish/County

City/Town/Post Office

Parish/County

State

Zip/Postal Code

Country

State

Zip/Postal Code

Country

b) Name of Contact (if any)

8. Home/Permanent Phone

  • b)

    Name of Contact (if any)

    • 9.

      Mailing Address Phone

c) Active Dates (if applicable) Fr ___/___/______ To ___/___/______

(

)

10.

Cell Phone

-

-

( 12.

) Fax Number

( 14.

Gender

)

-

)

-

)

-

( 11. Work Phone

(

  • 13.

    Email Address

  • 15.

    Date of Birth (dd/mm/yyyy)

Ext:

16. Tax Number /National ID

Marital Status

Single

Married

Legally Separated

Divorced

19. Country of Birth/National of

17.

Female

Male

______/______/____________ 18.Religion/Denomination

Common Law Widowed 20. Country of Citizenship

21. a) Country of Residence

b) Duration (yrs.)

22. Country of Responsibility for Fees (see Instruction _)

23. Father’s Nationality

25. a) Do you have a disability? (This information is needed in case special facilities are required)

  • 24.

    Mother’s Nationality

    • b)

      If yes, please specify

Yes 26. Emergency Contact Information:

No

a) Name Title

Last Name/Surname

First Name

Middle Initial

b) Relationship to Applicant

c)

Permanent Address Apt/Street/PO Box

d)

Emergency Contact Home/Permanent Phone

e)

(

)- Emergency Contact Cell Phone

City/Town/Post Office

Parish/County

f)

(

)- Emergency Contact Work Phone

(

)

-

Ext:

State

Zip/Postal Code

Country

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