Application for Special Admission

Application for Special Admission
1. Name

First NameLast Name
2.(a) Former name (if applicable)
(b) Type of former name

Maiden(Prior to) Deed Poll
3. Have you previously applied to UWI?

YesNo
4. Have you previously been a student at the UWI?

YesNo
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

24. (a) Are you a UWI staff member?

YesNo
(b) If yes, state: Staff Identification Number
(c) Campus:
(d) Department:
25. How did you obtain information about the UWI Co-curricular courses?

UWI AlumniSchool/College FairSchool VisitEmployerInternetMediaOther
SECTION C- Academic Record
26. Please list any short courses you have taken, and/or any computer competencies you possess, beginning with the most recent.
Institution name, from (mm/yy) to (mm/yy), Name of course.

SECTION D- Emergency Contact Information

Please indicate information for an emergency contact person
27. (a) Name

First NameLast Name
(b) Relationship to Applicant
(c) Permanent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
(d) Emergency Contact Home/Permanent Phone
Please enter a valid phone number.
(e) Emergency Contact Cell Phone
Please enter a valid phone number.
(f) Emergency Contact Work Phone

Ext.Phone Number

SECTION E- Declaration
I hereby certify that I have read and understood the instructions and the information necessary for completing this application and that all statements made are true and complete. I accept that the University reserves the right to reject this application if the information submitted in its support is based in whole or in part on deception or fraud.
YesNo
Date

DayMonthYear
Date
FOR OFFICIAL USE ONLY
Documents Received

Proof of paymentLetter from Head of Department (UWI Staff only)
State of approval

ApprovedNot approved
Signature of University Officer

Clear
Date

DayMonthYear
Date

SECTION B-Courses