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Diploma
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Please provide the following information:

Application For Admission



Program Preference

Bachelor's
Master's
Doctorate
Other (specify)
Major
(area of interrest)


Personal Information

Title Mr., Mrs., Ms, Miss, Dr.
First Name
Middle Name
Last Name
Gender Female       Male      
Citizenship
Date of Birth
Place of Birth
National ID Number
U.S. Social Security Number
Canadian Social Insurance Number
Other Country (specify) 


Contact Information

Preferred Mailing Address

Home    Business
Home Address
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
Cell Number
FAX
E-mail


Organization Information

Organization/
Employer
Position
Start Date
Organization Address
City
State/Province
Zip/Postal Code
Country
Phone
Fax
URL
Email

Please select the category which best describes your industry / organization:
Communications Professional Services
Education Real Estate
Financial Resources
Government Retail/Wholesale
Health Services Technology
Manufacturing Transportation
Non-Profit Utility
Other (specify)


Academic History

Secondary School
Location
Major
Attendance Dates
Date Degree Granted
GPA

College
Location
Major
Attendance Dates
Date Degree Granted
GPA

University
Location
Major
Attendance Dates
Date Degree Granted
GPA


References

Please provide two references
Name
Phone

Name
Phone


Credit for Work Experience Assessment

Describe your prefessianl experience relating to the degree you are seeking.
Position 1
Duties &
Responsibilities
Number of years
Position 2
Duties &
Responsibilities
Number of years
Position 3
Duties &
Responsibilities
Number of years

Summary

In your own words describe your qualifications
for the degree program for which you  are seeking
evaluation.


Declaration

I declare that all statements in this
application are complete and correct
to the best of my knowledge. 
Date



 

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