UNIVERSITY OF CAPE COAST
Tel: Fax:
03321-33304 03321-33303
Centre for International Education Email: Web:
[email protected] cie.ucc.edu.gh
APPLICATION FOR STUDY ABROAD EXCHANGE PROGRAMME INSTRUCTIONS: Please complete this form in block as legibly as possible. Please be sure to fill out all the blanks where applicable or risk having the application rejected.
(SECTION A) STUDENT’S DETAILS
1.
Surname:
2.
First Name:
3.
Middle Name (If Applicable):
4.
Date Of Birth:
5.
Gender:
6.
Nationality:
7.
Marital Status:
8.
Permanent Residential Address:
9.
Postal Address:
Day
a) Male [ ]
10. Primary Phone Number: 11. Email: 12. Passport Number: 13. Programme Of Study: 14. Faculty/School: 15. Registration Number:
Month b) Female [ ]
Year
16. Level: 17. Semester Applying For:
a) First [ ]
18. Source of Finances for the Programme:
b) Second [ ] a) Parent(s) [ ]
b) Other Relative [ ]
c) Other
(SECTION B) PARENT(S)/ GUARDIAN INFORMATION 1.
Surname:
2.
First Name:
3.
Other Names (If Applicable):
4.
Relationship To Student:
5.
Nationality:
6.
Gender:
7.
Occupation:
8.
Work Address:
9.
Permanent Residential Address:
10. Phone Number: 11. Email (Where Applicable):
Applicant’s Declaration: I hereby declare that to the best of my knowledge, the information I have given is correct. If information provided is proven to be incorrect and that the applicant knowingly provided incorrect information, it will lead to the disqualification of the applicant.
Signature:
Date:
(SECTION C) RECOMMENDATION FROM HEAD(S) OF DEPARTMENT(S) Name: Department: Recommendation:
Signature:
Date:
Official Stamp
Name: Department: Recommendation:
Signature: Official Stamp:
Date:
This form and all other documents required, stated below;
One passport-sized photograph, A recent statement of results, A letter of interest, A copy of current endorsed registration form and A copy of Passport bio-data page,
Should be returned to; The Dean Centre for International Education University of Cape Coast Cape Coast Ghana
(SECTION D) FOR OFFICIAL USE ONLY 1) Student Information Verified: 2)
Parent/Guardian Information Verified:
3) Application Status:
a) Approved [ ]
a) Accurate [ ]
b) Inaccurate [ ]
a) Accurate [ ] b) Inaccurate [ ] b) Not Approved [ ]
c) Deferred [ ]
4) (If Approved) Institution Allocated: 5) If Deferred or Not Approved, (Give Reasons and Recommendation):
