Mr. Gml

REGISTRATION/MATRICULATION NO: (For University use) Application Reference No (For University use) Credits Accumulated Modules required

Code University use only

Accepted

Conditional

Pending

Rejected

Application for Study at Heriot-Watt University Dubai Campus
PLEASE USE CAPITAL LETTERS ONLY Section A – TO bE COmPLETEd bY ALL APPLICANTS
Please refer to the enclosed Application Guidelines before completing this application and ensure that your application processing fee of AED 300 is included when you submit this to the Campus.

PROPOSEd PROGRAmmE
Course Title  Undergraduate Study Method of study  Postgraduate Study Start Date
(please check available dates) MM/YY

(please check whether a part-time option is available for your chosen course)

 Full-time

 Part-time

PERSONAL dETAILS
Title (Dr/Mr/Miss/Mrs/Ms/Other) First Name(s) Please affix a current colour passport photograph. This must be on a white background Please ensure that your referee signs the ‘Certificate Of Authenticity’ in section D of this Application Form

Surname/Family Name/Last Name

Date of Birth (DD/MM/YYYY)

* N.B. Kindly note that you must be under 25 years of age when you complete your undergraduate degree with us due to visa rules

Sex (Male/Female) Marital Status (Married/Single/Divorced/Separated) Permanent Address

Correspondence Address in UAE (if different)

Residence Tel No: Office Tel No: Mobile No: Fax No: Email Address:

Residence Tel No: Office Tel No: Mobile No: Fax No: Email Address:

YOU MUST INFORM HERIOT-WATT UNIVERSITY OF ANY CHANGE IN YOUR PERSONAL DETAILS

Nationality

Country of Birth

Country of Permanent Residence

Country of Current Residence

Passport No.

Date of Issue (DD/MM/YYYY) Date of Expiry (DD/MM/YYYY)

ETHNICITY
Ethnicity Code* * See Application Guidelines

VISA dETAILS
Do you hold a valid UAE Residence Visa? Visa No. Date of Issue (DD/MM/YYYY)  No Visa Type Date of Expiry (DD/MM/YYYY)  Yes... [continues]

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