Registration

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Name

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Last

Address

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City

State / Province / Region

Phone

Emergency Contact

Name

First

Last

Relationship to applicant

Address

Address Line 1

Address Line 2

City

State

Phone

Universities that are recipients of federal dollars are required by the Federal government to solicit certain demographic information to meet federal reporting requirements. Applications are requested to provide the following information voluntarily. This information will not be utilized in a discriminatory manner.

Nation of Citizenship

Native Language

Religion

Gender

Date / Time

This application is for enrollment as:

Certificate Training
Diploma Programme
Degree (BA) Programme
Masters Programme

What is your planned major?

If your records have been expunged pursuant to applicable law, you are not required to answer yes to the following questions. If you are unsure whether to answer yes, we strongly suggest that you answer yes and fully disclose all incidents to avoid any risk of disciplinary action or revocation of your offer of admission.

Are you currently or have you ever been charged with or subject to disciplinary action for scholastic or any other type of misconduct at any educational institution?

Upload Passport

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Please attach scanned credentials as a single pdf document

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Kindly fill the form correction with the right information. Falsify information can lead to disqualification.

Yes, I understand and agree to the terms listed above.

AMBI GUBUCHI

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