The University of the West Indies
The University of the West Indies
St. Augustine
Confirmation Receipt
Name (please print):___________________________ Programme of 1st Choice:______________________________
DOCUMENTS SUBMITTED:
The following documents are required. Please ensure that you submit these documents along with this signed page.
Birth Certificate
Marriage Certificate (where applicable).
Legal Affidavit or Deed Poll if present name is different from that on the Birth Certificate
Academic Certificates (GCE, CXC (CAPE), CXC (CSEC)). GCE/CXC (CSEC/CAPE) Grade Slips
(Accepted Only in cases where certificates are not yet available)
Professional Certificate/Diploma
Official transcripts [sent directly from granting Institution].
Autobiographical Statement (200 words)-Faculty of Medical Sciences –Mandatory
TOEFL Examination Score (if English is not native language). TOEFL Score of 500 or greater.
Supplemental Sheet 1 (if you are due to write examinations or are awaiting examination results)
Supplemental Sheet 2 (for undergraduate applicants Bed Primary Education, BSc Human Ecology and
Certificate of Specializations in Tropical Agriculture)
Supplemental Sheet 3
Other (please specify) _____________________________________________________
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 intend to provide such fees as may be payable to the University. I understand that otherwise my admission to or registration in the University may be revoked.
______________________________________ ______/______/___________
Signature of Applicant Date (dd/mm/yyyy)
FOR OFFICIAL USE ONLY
|STATUS: Full-time Part-time Evening |
|OFFICIAL ASSESSMENT |
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|Undergraduate applicants only: |
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|Qualified |
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|Other Qualifications Qualifying |
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|Refer for decision re Matriculation Not Qualified Re-entry |
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|Sponsored Contributing Non Sponsored Contributing Non-Contributing |
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|__________________________________ ______/______/____________ |
|Signature of University Officer Date (dd/mm/yyyy) |
The University of the West Indies
St. Augustine
Supplemental Sheet 1
Academic Programmes or Examinations in Progress
|List academic programmes or examinations for which you are currently preparing or awaiting examination results. |
|Examining Body |Level |Subject/Programme |Date of Exam |Grade [official|
|(e.g. CXC, CSEC, UWI) | | |(dd/mm/yyyy) |use only] |
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The University of the West Indies
St. Augustine
Supplemental Sheet 2
Specialisations
Applicants to the following programmes, please indicate which area you would like to specialize in:
BEd Primary Education
Educational Administration
Language Arts
Mathematics
Science
Social Studies
BSc Human Ecology
Nutrition & Dietetics
Consumer Sciences
Certificate of Specializations in Tropical Agriculture:
Agricultural Marketing
Agribusiness Management
Agro-environmental Management
Rural Development, Communications & Education
The University of the West Indies
St. Augustine
Supplemental Sheet 3
Employment and Referee Information
Employment Information:
Please provide information on your entire work experience. This is particularly helpful in the case of mature applicants.
|List employment information starting with your current job |
|a) Name of Employer |b) Name of Employer |
| | |
|Position |Position |
|Address: Apt/Street/PO Box |Address: Apt/Street/PO Box |
| | |
| | |
|City/Town/Post Office |Parish/County |City/Town/Post Office |Parish/County |
|State |Zip/Postal Code |Country |State |Zip/Postal Code |Country |
|From |To |From |To |
|_____/______/___________ |_____/______/____________ |_____/______/____________ |_____/______/____________ |
|c) Name of Employer |d) Name of Employer |
| | |
|Position |Position |
|Address: Apt/Street/PO Box |Address: Apt/Street/PO Box |
| | |
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|City/Town/Post Office |Parish/County |City/Town/Post Office |Parish/County |
|State |Zip/Postal Code |Country |State |Zip/Postal Code |Country |
|From |To |From |To |
|_____/______/___________ |_____/______/____________ |_____/______/____________ |_____/______/____________ |
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|Referee Information |
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|Certificate, Diploma and Mature Applicants must submit two(2) referee reports. |
|Name Two Referees (Certificate, Diploma & Mature Applicants for Associate Degrees only) (Recommendation from your employer must accompany application) |
|a) Name of Referee |b) Name of Referee |
|Name of Organization |Name of Organization |
|Position |Position |
|Address: Apt/Street/PO Box |Address: Apt/Street/PO Box |
| | |
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|City/Town/Post Office |Parish/County |City/Town/Post Office |Parish/County |
|State |Zip/Postal Code |Country |State |Zip/Postal Code |Country |
|Telephone Number |Fax Number |Email Address | Telephone Number |Fax Number |Email Address |
|( ) -|( ) - | |( ) - |( ) - | |
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