Admission Form PAF

Pathway International College Birmingham

Admission Form

www.pathwaycollege.org.uk

For Office Use Only Ref Intake Course Fee Paid

: __________________________ : __________________________ : __________________________ : __________________________

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Please make sure that you have read the TERMS & CONDITIONS before to fill this application form.

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Please fill the form in CAPITAL LETTERS.

Mode of Payment: Cash / Cheque / DD / C-Card

Mr / Mrs / Miss / Ms: _______________________________________ Age: ___________ Date of Birth: _________ _____ dd / mm / yyyy Full Name (as per your passport): ______________________________________________________________________

Nationality: ____________________________________ Country of Birth: ______________________________________

Permanent Address: ___________________________________________________________________________________________________

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

Correspondence Address: (if different from above) ___________________________________________________________________________________________________

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

Tel: ____________________________ Fax: ____________________________ Email: _______________________________________ (Including country code)

Course Applying for: (2 choices) 1. _________________________________________________________________________________________________

2. _________________________________________________________________________________________________

Intake/Session: January / June / September/ 200__

English Language: IELTS _____________________________, TOEFL ____________________ Date: __ /__ _/____ overall band score dd mm yyyy

Level

Academic Details: Name of Institute

From

To

Main Subjects

Certificate / Degree

Grade

Employment History: Name of Employer

From

To

Position

Reference: Please name two references, which should normally be your academic teachers, and incase of you are employed please ONE academic and ONE work reference.

Reference-1

Reference-2

Name:

Name:

__________________________________

________________________________________

Position: __________________________________

Position: ________________________________________

Address: __________________________________

Address: ________________________________________

__________________________________

________________________________________

__________________________________

________________________________________

__________________________________

________________________________________

Country: __________________________________

Country: ________________________________________

Tel:

__________________________________

Tel:

________________________________________

Fax:

__________________________________

Fax

________________________________________

Email:

__________________________________

Email:

________________________________________

Statement of Purpose: Please write some word to express why you are interested in the applied course and what are your academic objectives. ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________

How did you hear about us: Internet Student/Friend Education Fair/Exhibition Agent / Representative _________________________________________________________________________________ (Please specify) Any other ___________________________________________________________________________________________ (Please specify)

Declaration of Criminal Record: Do you have any criminal record?

Yes

No

If yes, please specify ____________________________________________________________________________________

Declaration: I here by acknowledge that I have read all the terms and conditions and I give my consent to the processing of my admission to Pathway College. I also acknowledge that all the information provided in this form by me the true and accurate and I will abide them.

Name of the student: __________________________________________________________________________________

Signature of student: ____________________________________________________________ Date:

/ dd

mm

/_____ yyyy