UNIVERSITY OF CAPE COAST CENTRE FOR INTERNATIONAL EDUCATION STUDY ABROAD STUDENT APPLICATION (October 2016) Please complete this form in its entirety using BLOCK letters. Completed applications should be sent to the Centre for International Education (CIE) at the University of Cape Coast (UCC). All applications must include the following to be considered complete: 1. 2. 3. 4. 5. 6. 7. 8. 9.

Official transcript(s) from the home university and any other previously attended tertiary institutions. A statement of interest. A current CV or résumé, and the bio-data page of passport. Proof of Financial support. A letter of support from your home institution. Six (6) recent physical passport-size photographs (Two of which will be required by the Ghana Immigration Service for extension of permit while in Ghana). Your name should be written on the back of each photograph. Application fee of $100.00 USD (students from Affiliate Partner Institutions are exempted from paying this fee) Submit two copies of this application. Students from non-partner institutions would pay the required tuition fee.

BIOGRAPHICAL INFORMATION Family Name:

Given Name:

Other Names:

Sex:

Nationality:

Date of Birth: (d/m/yr)

Male

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Female

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Place of Birth: CONTACT INFORMATION PERMANENT ADDRESS Address:

Phone:

Fax:

Email:

HOME INSTITUTION CONTACT PERSON AND ADDRESS Name: Address:

Tel:

Fax:

Email:

FOR OFFICIAL USE ONLY Application Fee:

Application Vetted By:

Receipt No.:

Date: (d/m/yr)

ID No.:

Signature:

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EDUCATION Attendance Dates From (m/yr) To (m/yr)

Name of School/College & Location

Particulars of Offices held and/or other activities at school

Level of Study

First Year

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Second Year

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Third Year

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Final Year

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Graduate Student

EMPLOYMENT HISTORY List Particulars of Past and Present Employment and Dates: Institution/Organization

Position Held

Dates

COURSE SELECTION Please indicate your course selection preferences. First Choice COURSE CODE COURSE TITLE

Alternative Selection (If First Choice is not Available) COURSE TITLE

COURSE CODE

FINANCIAL INFORMATION Please indicate how you plan to finance your study at the University of Cape Coast.

□Self

□Government Aid

□Family Assistance

□Other 2

EMERGENCY CONTACT PERSON(S) Name: Address:

Home Phone:

Work Phone:

Mobile:

Email:

Other Information:

APPLICATION INFORMATION Have you ever applied for admission to the University of Cape Coast before? Yes

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No

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If Yes, when did you apply? (d/m/yr) What were your reasons for not attending at that time?

IMPORTANT: AN APPLICANT WHO MAKES A FALSE STATEMENT OR WITHHOLDS RELEVANT INFORMATION MAY BE REFUSED ADMISSION. IF HE/SHE HAS ALREADY COME INTO THE UNIVERSITY, HE/SHE MAY BE ASKED TO WITHDRAW.

Signature:

Date: (d/m/yr)

DECLARATION This declaration should be signed by someone of high repute who should also endorse one of the passport-sized photographs on the reverse side. The person should be an official representative from your home institution. The application will not be valid if this declaration is not signed. I certify that the photograph endorsed by me is the true likeness of the applicant. Mr./Miss/Mrs. who is personally known to me. I have inspected his/her certificates and I am satisfied that the names on them conform to those by which, to the best of my knowledge, he/she is officially known.

Name: Position:

Address:

Signature:

Date: (d/m/yr)

Note: All documents submitted in connection with this application become the property of this University.

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