APPLIC ATION FOR ADMISSION - UCC HomeIndicate your level of English Language proficiency, by...
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Executive Training A P P L I C A T I O N F O R A D M I S S I O N INSTRUCTIONS: PLEASE COMPLETE ALL SECTIONS OF THIS FORM • Answer ALL sections in BLOCK CAPITALS • One (1) passport size photograph should accompany this form • Attach all supporting documents (eg. Copy of degree/certification, reference form, CV/resume & one (1) gov. issued ID) • A non-refundable processing fee of US $15.00 (or equivalent) must accompany this application PLEASE NOTE: • Study option may be withdrawn in the event of under-enrolment in a given programme. • All supporting documents submitted with applications become the property of the University College of the Caribbean and will not be returned to applications. Indicate your level of English Language proficiency, by placing a number from 1 to 5 in the appropriate space (1 = “very poor” and 5 = “excellent”) WRITTEN ORAL PLEASE AFFIX YOUR PHOTO Programme for which you are applying: Transcript Fee Course Fee (Please indicate your first and second choices by placing a 1 or 2 in the appropriate boxes. Thank you) Sales and Marketing Computer Studies Communication Skills Entrepreneurship Executive Seminars Finance Management/Leadership Human Resource Management Risk Management Project Management Evening Online Sunday Other Study Options: State the semester and the year you intend to commence your programme March/April (20___) September (20___) January (20___) 1 1 2 3 4 5 6 8 7 9 10 11 12 13 14 15 16 2 3 4. Have you previously attended IMS, IMP or UCC? 5. List previously held UCC/IMP/IMS ID number(s) 6. Are you enrolled with UCC? 7. Do you have access to high speed internet at 8. Do you have access to high speed internet at No No No No Yes Yes Yes Yes (From _____________ to _____________ ) (From _____________ to _____________ ) Programme____________________________________ Work Home Last Name Maiden Name (if applicable) First Name Middle Name Date of Birth (mm/dd/yyyy) Gender Male Female Marital Status Single Married Divorced Widowed Nationality Email Address (Print in block letters) Country of Residence Country of Birth Home Own Rent Live with family Income $1,000 - $8,000 per week $8,500 - $12,000 per week $12,500 - $18,000 per week $80,000 - $200,000 per month $200,000 + per month Do you have physical disabilities/health conditions? No Yes (Please state) Home Number Mobile Number Work Number Mailing Address Permanent Address (if different from mailing address) N.B. Please submit a complete Résumé/CV along with your application Present Employer/Self Employed Total Years of Employment Number of Years in Present Employment Current Position/Job Title Employer’s Telephone Number Employer’s Fax Number (Next of Kin) Last Name First Name First Name Relationship Relationship Telephone Number Telephone Number (Emergency Contact) Last Name SECTION A: Professional Background/Area of Interest SECTION B: Personal Data
Transcript of APPLIC ATION FOR ADMISSION - UCC HomeIndicate your level of English Language proficiency, by...
Executive TrainingA P P L I C A T I O N F O R A D M I S S I O N
INSTRUCTIONS: PLEASE COMPLETE ALL SECTIONS OF THIS FORM• Answer ALL sections in BLOCK CAPITALS• One (1) passport size photograph should accompany this form• Attach all supporting documents (eg. Copy of degree/certification, reference form, CV/resume & one (1) gov. issued ID)• A non-refundable processing fee of US $15.00 (or equivalent) must accompany this application
PLEASE NOTE:• Study option may be withdrawn in the event of under-enrolment in a given programme.• All supporting documents submitted with applications become the property of the University College of the Caribbean and will not be returned to applications.
Indicate your level of English Language proficiency, by placing a number from 1 to 5in the appropriate space (1 = “very poor” and 5 = “excellent”)
WRITTEN ORAL
PLEASE AFFIX
YOUR PHOTO
Programme for which you are applying: Transcript Fee Course Fee
(Please indicate your first and second choices by placing a 1 or 2 in the appropriate boxes.Thank you)Sales and MarketingComputer StudiesCommunication SkillsEntrepreneurshipExecutive Seminars
FinanceManagement/LeadershipHuman Resource ManagementRisk ManagementProject Management
Evening Online
Sunday Other
Study Options:State the semester and the yearyou intend to commence your programme
March/April (20___)
September (20___)
January (20___)
1
1
2 3
4 5 6
87
9
10
11
12
13 14
15
16
2 3
4. Have you previously attended IMS, IMP or UCC?
5. List previously held UCC/IMP/IMS ID number(s)
6. Are you enrolled with UCC?
7. Do you have access to high speed internet at
8. Do you have access to high speed internet at
No
No
No
No
Yes
Yes
Yes
Yes
(From _____________ to _____________ )
(From _____________ to _____________ ) Programme____________________________________
Work
Home
Last Name
Maiden Name(if applicable)
First Name Middle Name
Date of Birth(mm/dd/yyyy)
Gender Male Female
Marital Status Single
Married
Divorced
Widowed
Nationality Email Address (Print in block letters)
Country of ResidenceCountry of Birth
Home Own Rent Live with family
Income $1,000 - $8,000per week
$8,500 - $12,000per week
$12,500 - $18,000per week
$80,000 - $200,000per month
$200,000 +per month
Do you have physical disabilities/health conditions? No Yes (Please state)
Home Number Mobile Number Work Number
Mailing Address Permanent Address (if different from mailing address)
N.B. Please submit a complete Résumé/CV along with your application
Present Employer/Self Employed Total Years of EmploymentNumber of Years in Present Employment
Current Position/Job Title Employer’s Telephone Number Employer’s Fax Number
(Next of Kin) Last Name First Name
First Name
Relationship
Relationship
Telephone Number
Telephone Number(Emergency Contact) Last Name
SECTION A: Professional Background/Area of Interest
SECTION B: Personal Data
1 2
SECTION C: Source of Funding
SECTION D: Educational Background and Professional Qualifications
What is your source of funding?
Self
Family Member
Employer
Local Loan
Overseas Loan
Sponsorship
If receiving sponsorship:
a. Organization
b.Authorizing Personnel
c. Position
d. Telephone#
e. Level of Sponsorship
Complete Partial (Amount) $
Signature:
OFFICIAL STAMP OF
SPONSORING ORGANIZATION
2. Highest degree earned prior to the anticipated term of enrollment
Bachelor’s Master’s Doctoral Specialist Others
Earned GPA:
Bachelor’s
Masters
2a. Educational BackgroundTertiary Institution Attended Course/Programme Pursued Year
Year Level
Award Result
2b. Professional Qualifications (ACCA etc.)Qualification Association/Institution
Tell us how you heard about UCC.
PrintNewspaperMagazineBrochureFlyer
Electronic MediaLocal TVCable TVRadio Programme/AdElectronic Board
WebsiteEmail BlastSMSSocial Media
Word of MouthFriendRecruiterUCC StaffOther (Please specify)
OFFLINE ONLINE | NEW MEDIA DIRECT
UCC Event/PromotionOther Event/Promotion
SECTION E: How Did You Hear About Us?
SECTION F: Referee Information
SECTION G: Declaration
FOR OFFICIAL USE ONLY
Decision:
UCC Recruiter
Please provide contact information for the two referees (See reference form attached)
NAME (FORM A) COMPANY/ORGANIZATION
COMPANY/ORGANIZATION
TELEPHONE NUMBER
TELEPHONE NUMBERNAME (FORM B)
APPLICANT’s SIGNATURE
NAME OF UCC REPRESENTATIVE SIGNATURE
SIGNATURE
DATE
DATENAME OF UCC REPRESENTATIVE
STUDENT ID#
DATE
1.
2.
1. My signature certifies that I have read, understood and agree to the terms and condition of this application and upon acceptance further agree to abideby the policies, rules and regulations of the institution.
2. I understand that the institution has the right to exclude any student at any time in keeping with its regulations, when such an act is deemed to be in the best interest of either the student, student body, or the institution.
3. I understand that falsification of information or withholding information requested may make me ineligible for admission or continuation of studies.
Full Acceptance Provisional Acceptance Denied
Outstanding Documents:
Remarks:
/ /
/ /
NAME I.D. NUMBER/POSITION
