International Summer School - University of Nottingham Application Form (2014)

Transcription

1 International Summer School - University of Nottingham Application Form (2014) 1. PERSONAL DETAILS First Name(s): Family Name/Last Name: (This is the name under which your file will be registered) Title Male/Female Date of Birth Nationality Day Month Year Correspondence address: (Please write clearly) Home address: (If different from correspondence address) Home number: (With international code) Mobile number: (With international code) Occupation: (If a full-time student, please state your academic institution here)

2 2. YOUR CHOICE OF COURSE Please state your preferred course choice. If you are interested in more than one course, please provide a second choice. The Malaysia Campus Doing Business in Asia Politics, Culture and the Media in Southeast Asia Beginning Creative Writing 1 st Choice 2 nd Choice *please leave blank if you have no second choice 3. QUALIFICATIONS AND GENERAL EDUCATIONAL BACKGROUND Undergraduate Institution Course/ Programme Result or Predicted Result Date awarded or expected Postgraduate Other 3.1 English Proficiency: Results Date of Test Taken IELTS TOEFL CAMBRIDGE First Certificate Others Please attach your scanned test certificate with your application.

3 3.2 Referee: Please give details of a person whom we may contact concerning your application. Name of referee: Occupation: Fax No: Telephone No: Relationship to applicant: 3.3 Emergency Contact Details Name of Emergency Contact Person: Occupation: Fax No: Telephone No: Relationship to applicant: 3.4 Have you ever studied at the University of Nottingham before or applied to study at the University of Nottingham (Applicants should answer Yes even if study was not completed.) YES/NO If YES Which year? Which course? 4: PAYMENT DETAILS Will you be paying for the course yourself? YES NO If YES there are three ways to pay your deposit when booking. 1. Credit Card/ Debit Card Debit or Credit cards covered by MasterCard/Visa/American Express are accepted via our online payment by following these steps:- Step 1: Click Step 2: Select Others under the Fees Name Step 3: Fill up your personal details

4 Step 4: Key in Non-Nottingham/U21 student RM950 Nottingham/U21 student RM750 3rd world countries/developing nations RM500 as a 20% deposit to confirm a seat 2. Cheques or Bank Draft Please make your Crossed cheque or bank draft payable to 'The University of Nottingham in Malaysia Sdn Bhd for the deposit Please send your cheques/bank drafts to: International Summer Schools The University of Nottingham Malaysia Campus Jalan Broga, 43500, Semenyih, Selangor MALAYSIA 3. Bank transfers (telegraphic transfers) or direct bank-in to the following bank: HSBC Bank Malaysia Berhad Main Branch 2 Leboh Ampang Kuala Lumpur Bank Account Number: Swift code: HBMBMYKL As for the optional tours, an additional RM200 should be paid to confirm your bookings except for the FRIM tour. Deposit for the fees and the tours, should be made by 9 June 2014 Full settlement of the fees and the tours must be made by 23 June 2014 It is your responsibility to ensure that the fees are paid in full by the correct date. If NO, please provide contact details of your sponsor, including any reference code your sponsor may require.

5 4.1 Sponsor Details Name: Reference Code: Contact Telephone No: Contact Contact Fax No: SECTION 5: SOURCE Where did you learn about the University of Nottingham Summer School? Internet University Friends/Previous student/colleagues Employer Advertisement Other (please specify) I declare that the information supplied in this form is true to the best of my knowledge and belief. Signature:*. Date:.. *You may be required to sign in person at the start of your course. *Please return your completed application form to SUMMER SCHOOL MALAYSIA ; SummerSchool.Malaysia@nottingham.edu.my Disclaimer: Although all possible care has been taken in the preparation of this form, no responsibility can be taken for any errors or omissions, however caused. Should a course need to be cancelled due to unforeseen circumstances, the applicant will be offered an alternative course or a full refund of tuition fees and accommodation deposit.