AIMS APPLICATION FOR ADMISSION

[ZIKPHYSICS]

APPLICATION FOR ADMISSION
POSTGRADUATE DIPLOMA IN MATHEMATICAL SCIENCES
SEPTEMBER 2010 INTAKE
Please complete the application in block letters.
Surname/ Nom (as in passport):
Given name(s)/ Prenom (as in passport):
Full names (all names as in passport):
Gender: Male Female
Correspondence address:
City Postcode: Country:
Address above valid until:
Home address (if different from above):
Telephone: Fax:
E-mail:.
Date of Birth: Nationality:
Country of Birth:
Country of normal residence:
Details of current occupation:
Secondary education:
____________________________________________________________________
Higher education:
Please list in the following table in reverse chronological order all
the institutions of higher education
that you have attended and the degrees or other qualifications
attained. (Attach additional sheets if
necessary). Please indicate the expected graduation date of your
current program.
1. Name of Institution:
Address:
City: Postcode: Country:
Dates of attendance .............................................
to .....................................................
Type of program:
Degrees attained:
Class rank or grade point average:
2. Name of Institution:
Address:
City: Postcode: Country:
Dates of attendance .............................................
to .....................................................
Type of program:
Degrees attained:
Class rank or grade point average:
3. Name of Institution:
Address:
City: Postcode: Country:
Dates of attendance .............................................
to .....................................................
Type of program:
Degrees attained:
Class rank or grade point average:
Certified copies of a full official statement or transcript of your
academic record from each institution
and of your degree certificate(s) are required.
Please list any other relevant skills (e.g. Computing),
qualifications, or work experience:
_____________________________________________________________________
Scholarships, prizes, and other distinctions obtained:
Names and addresses of two senior persons acquainted with your
academic work whom you have asked
to write on your behalf indicating your academic fitness and general
suitability to undertake the course
for which you are applying. These testimonials must be enclosed with
this application form in sealed
envelopes or returned directly to us by the referee. Your application
will not be considered unless two
testimonials are received. "Open" testimonials are not acceptable.
Referee 1:
Name:
Position:
Address:
Phone: E-mail:
Referee 2:
Name:
Position:
Address:
Phone: E-mail:
Statement of your mathematical and scientific interests and future
career plans:
The AIMS course will be taught in English. Some language tutoring will
be provided. Please describe
the standard of your knowledge of spoken and written English and other
languages. For students from
Arabic, Francophone, or Lusophone countries, please list any
qualifications that you have in written and
spoken English.
Name and address of nearest relative or person who should be informed
in case of emergency:
Telephone:
Other interests and activities:
How did you hear about the AIMS programme?
I confirm that the information that I have given in this application
is true and correct
to the best of my knowledge.
SIGNATURE:
DATE:
Information given in this form will be used to form part of a
computerised record and to inform
admission decisions.