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c) Name of Employer

d) Name of Employer

Position

Position

Address: Apt/Street/PO Box

Address: 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

From

To

From

To

_____/______/___________

_____/______/____________

_____/______/____________

_____/______/____________

SECTION F – REFEREE INFORMATION 50. Name Two Referees (Certificate, Diploma & Mature Applicants for Associate Degrees only)

a) Name of Referee

b) Name of Referee

Name of Organization

Name of Organization

Position

Position

Address: Apt/Street/PO Box

Address: 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

SECTION G - DECLARATION

51. I hereby certify that I have read and understood the instructions and the

52. This application is made with my consent and I intend to provide such fees as

information necessary for completing this application and that all statements made are true and complete. I intend to provide such fees as may be payable to the University. I understand that otherwise my admission to or registration in the University may be revoked.

may be payable to the University.

FOR OFFICIAL USE ONLY Original Documents Returned:

Documents Received: Application Fee Birth Certificate Marriage Certificate Deed Poll Transcripts CXC/GCE Certificates Referee Reports Other (specify):_______________________________________________

Receipt no.:

__________________________

__________________________________ Signature of Applicant

______/______/____________ Date (dd/mm/yyyy)

__________________________________ Signature of University Officer

______/______/____________ Date (dd/mm/yyyy)

  • O

    AU

_______________________________ Signature of Applicant

OFFICIAL ASSESSMENT:

Qualified

D

A

______/______/____________ Date (dd/mm/yyyy)

______/______/___________

__________________________________

Date (dd/mm/yyyy)

Signature of Parent/Guardian

Qualifying

F

QA

Not Qualified

U

Non Sponsored Contributing

NS

Sponsored Contributing

S

Other Qualifications

X

Refer for decision re Matriculation

M

OU

QO

Re-entry

R

Non-Contributing

NC

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