Olive Senior Poem

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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 2. a) Former Name (if applicable) Title Last Name/Surname 3. Have you previously applied to the UWI? Yes No First Name Middle Name(s)

First Name

Middle Name(s)

b) Type of Former Name: Maiden (Prior to) Deed Poll c) To (year) d) Campus

5. If answer to question 4 is yes, please state the following: a) Identification Number e) Programme 7. a) Mailing Address (if different from 6): Apt/Street/PO Box b) From (year)

4. Have you previously been a student at the UWI? Yes 6. a) No Permanent Address: Apt/Street/PO Box

City/Town/Post Office State

Parish/County Zip/Postal Code Country

City/Town/Post Office State

Parish/County Country

Zip/Postal Code

b) Name of Contact (if any) 8. Home/Permanent Phone ( ) 10. Cell Phone ( ) 12. Fax Number ( ) 14. Gender -

b) Name of Contact (if any) 9. Mailing Address Phone ( ) 11. Work Phone ( ) 13. Email Address 15. Date of Birth (dd/mm/yyyy) ______/______/____________ 18.Religion/Denomination Common Law Widowed 20. Country of Citizenship -

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

Ext:

16. Tax Number /National ID

Female Male 17. Marital Status Single Married Legally Separated Divorced 19. Country of Birth/National of

21. a) Country of Residence 24. Mother’s Nationality

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) b) If yes, please specify Yes 26. Emergency Contact Information: a) Name Title Last Name/Surname c) No

First Name d) ( e) (

Middle Initial

b) Relationship to Applicant

Permanent Address Apt/Street/PO Box

Emergency Contact Home/Permanent Phone ) Emergency Contact Cell Phone ) Emergency Contact Work Phone ) Ext:

City/Town/Post Office State

Parish/County Zip/Postal Code Country

f) (

27. a) Are you a UWI Staff Member? Yes No 28. a) Are you a dependent of a UWI Staff Member? Yes No If yes, state: If yes, state: b) Staff Identification Number: ___________________________________ b) Name of Staff Member: _____________________________________ c) Campus/NCC: ___________________________________ c) Relationship to applicant: _____________________________________ d) Department: ___________________________________ d) Campus/NCC: _____________________________________ e) Department: _____________________________________ c) If no, state preference for Hall attachment 29. a) Do you wish to live in a Hall of Residence? b) If yes, state Hall (see Instruction ____)

Yes No 30. How did you obtain information about the UWI? UWI Alumni Direct Mail School/College Fair School Visit

Employer Internet Other : Please specify _______________________________

Media

SECTION B – CAMPUS, FACULTY, PROGRAMME & STATUS For Faculty of First Choice, indicate the following: 31. Faculty of First Choice 32. a) Campus b) Mode of Delivery 33. Programme 34. Status Engineering (UWIDEC Applicants only) Gender & Development Studies Cave Hill Degree Full Tertiary Level Time Humanities & Education Mona Institution Diploma Law Part Medical Sciences St. Augustine Certificate Time Distance Pure & Applied Sciences Please state Preferred Site OR UWIDEC Associate Science & Agriculture SCS UWI Centre Degree Social Sciences SCS _______________________ OR School of Continuing Studies For Faculty Second Choice, indicate the following: 37. Faculty of Second Choice 38. a) Campus b) Mode of Delivery 39. Programme 40. Status Engineering (UWIDEC Applicants...
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