1. Name
*
Last Name
2. (a) Former name (if applicable)
(b) Type of former name
Maiden
(Prior to) Deed Poll
3. Have you previously applied to UWI?
*
Yes
No
4. Have you previously been a student at the UWI?
*
Yes
No
5. If answer to question 4 is yes, please state the following: (a) Identification Number
(b) From(year) (c) To (year)
(d) Campus
(e) Programme
6. Permanent address
*
Street Address Line 2
*
City
*
State / Province
*
Postal / Zip Code
*
7. Mailing address (if different from Permanent address)
Street Address Line 2
City
State / Province
Postal / Zip Code
8. Home/Permanent Phone
*
9. Mailing Address Phone
10. Cell Phone
11. Work Phone
12. Fax number
13. Email address
*
14. Gender
*
Male
Female
15. Date of birth
*
16. National ID/Driver's Permit number
*
17. Marital status
*
Single
Married
Common Law
Legally Separated
Divorced
Widowed
18. Country of Birth/National of
*
19. Country of Citizenship
*
20. (a) Country of Residence
*
(b) Duration (years)
*
21. (a) Do you have a disability? (This information is needed in case special facilities are required)
*
Yes
No
(b) If yes, please specify.
22. Please choose the course(s) you wish to take at the UWI:
*
First Aid, CPR, AED
Meditation for Holistic Health
Microsoft Excel 2019
Microsoft PowerPoint 2019
Microsoft Office Word 2019
Public Speaking & Voice Training
Introduction to Sign Language
The Basics of Steel Pan
Financial Literacy
Technology Literacy
Ethics and Integrity: Building Moral Competencies
Discover Microsoft 365 Collaborative Tools
Microsoft Excel Expert 2019
23. Please choose alternative courses in the event that the courses you chose above are unavailable:
*
First Aid, CPR, AED
Meditation for Holistic Health
Microsoft Excel 2019
Microsoft PowerPoint 2019
Microsoft Office Word 2019
Public Speaking & Voice Training
Introduction to Sign Language
The Basics of Steel Pan
Financial Literacy
Technology Literacy
Ethics and Integrity: Building Moral Competencies
Discover Microsoft 365 Collaborative Tools
Microsoft Excel Expert 2019
Please verify that you are human
*
24. (a) Are you a UWI staff member?
*
Yes
No
(b) If yes, state: Staff Identification Number
(c) Campus:
(d) Department:
25. How did you obtain information about the UWI Co-curricular courses?
*
UWI Alumni
School/College Fair
School Visit
Employer
Internet
Media
other
Other
26. Please list any short courses you have taken, and/or any computer competencies you possess, beginning with the most recent.
27. (a) Name
*
Last Name
*
(b) Relationship to Applicant
*
(c) Permanent Address
*
Street Address Line 2
*
City
*
State / Province
*
Postal / Zip Code
*
(d) Emergency Contact Home/Permanent Phone
*
(e) Emergency Contact Cell Phone
(f) Emergency Contact Work Phone
Yes
No
Date (dd/mm/yyyy)
*
Documents Received
Proof of payment
Letter from Head of Department (UWI Staff only)
State of approval
Approved
Not approved
Date (dd/mm/yyyy)
Comments
Submit
Should be Empty: