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APPLICATION FORM The information you provide on this form will be used to screen and short-list applicants. Short-listed applicants will be invited to sit for an AUW-administered entrance exam and personal interview at a location designated by the country coordinator. Final admissions will be made after the entrance exam results and personal interview evaluation have been submitted to the University. Please provide all information in CAPITAL letters.
Please ensure that you have submitted a complete application: Completed Application Form Completed Financial Aid Application Form One Institutional Recommendation Form
Please staple here two (2) passport-sized photos of the applicant. Please write the applicant’s name in capital letters on the back.
A. PERSONAL DETAILS
1. Applicant Particulars
a. Official Name (As in the Passport or Academic Transcript):
_____________________ _____________________ _____________________ Last First Middle
b. Age: c. Date of birth: __ __ ____ dd mm yyyy
d. Nationality: e. Ethnicity: f. Place of Birth: _________________ ____________________ __________________
Village/town/ city State/ Province Country g. Religion: i. Marital Status: h. Languages:
2. Contact information
a. Address: Home Address Postal Address (if different from home address)
b. Country: c. Phone: d. Email:
3. Possible area(s) of major(s): Please check all that apply. Asian Studies Politics, Philosophy & Economics Biological Sciences
Public Health Environmental Sciences
Possible career interest:
Office of Admissions Asian University for Women 20/G.M.M. Ali Road, Chittagong - 4000 Bangladesh Tel: +880-31-2854980 Fax: +880-31-2854988 Email: [email protected] Website: www.asian-university.org
Applicant ID:
Name:
Country:
For the Office of Admissions Use Only
Application Deadline: 12/02/2011 (Bangladesh) 28/02/2011 (International)* *Please check website for application deadline of different countries.
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4. How did you learn about the Asian University for Women? Please check all that apply. Country Coordinator School Presentation Recruitment materials Parents/Family member
Internet NGO announcement School official Newspaper
Radio Flyer/Poster AUW student Other: ______________________
B. ACADEMIC PERFORMANCE
5. Academic Marks Please attach certified or attested copies of all available public board examinations, certificates and transcripts from secondary and higher secondary school. Please ensure all documents are in English or translated into English. Attachments
Year (Please indicate the year of exam)
a. Class 10 public board examinations: Attached N/A b. Class 11 public board examinations: Attached N/A c. Class 12 public board examinations: Attached N/A d. Higher secondary school test scores: Attached N/A e. Secondary Certificate: Attached N/A f. Higher Secondary Certificate: Attached N/A g. Other international examinations: (e.g., O/A Levels/SAT/TOEFL/IELTS/IB)
Attached N/A
6. Most Recent Higher Secondary Institution
School name: No. of students in Class 12: Address:
Principal: Email: Phone:
7. Secondary and Higher Secondary Information
Please list all secondary and higher secondary schools (including any college/university programs attended) attended, beginning with the most recent.
School Name Years of Attendance
Class Location (City/Town)
Medium of Instruction
Boarding? (Y/N)
(a)
(b)
(c)
(d)
8. Scholastic Awards
Award Year Description
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C. EXTRACURRICULAR AND COMMUNITY ACTIVITIES
9. Activities (if any) Briefly list significant extracurricular and community activities that you have participated in secondary or higher secondary school (e.g.: sports, dance, music, arts, class monitor, clubs, food relief, local fair, community service, etc.). Please indicate special distinctions or awards obtained. Activity/Organization Leadership Role/Awards, if any Year/Length of involvement
10. Hobbies and Interests (outside school)
D. PERSONAL RESPONSIBILITIES
11. Work Experience (if any) Please list paid jobs you have held during the past three years (e.g., tutoring). Nature of Work Employer Dates Hours per week
12. Family responsibility Please discuss the nature and extent of your family responsibilities, if any:
E. PERSONAL ESSAY Please write an essay (between 250 - 300 words) on one of the topics below. This personal essay will help acquaint us with you as a person and student. It will also demonstrate your ability to organize your thoughts and express yourself.
If you could in history, who would it be and why? spend an evening with anyone
Discribe what your hopes are for your future –
whether for yourself, your community or your country. Describe a significant challenge or risk that you have experienced or undertaken in your life that required courage.
F. CERTIFICATION I certify that all information provided on this form and supporting documents submitted in the admission process is my own work, factually true, and honestly presented. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation or expulsion, should the information I’ve certified be false. X Student’s Signature Date
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RETURN ADDRESSES Candidates from the countries listed below should send their complete Application Form to the country coordinator for their respective country. Application Forms may also be directly submitted to the Admissions Office located in Chittagong, Bangladesh. Bangladesh/All Other Countries Office of Admissions 20/ G M. M. Ali Road Chittagong – 4000 Bangladesh Email: [email protected]
Bhutan Ms.Tashi Zangmo, Mr. Lungtaen Gyatso Executive Director, Bhutan Nuns' Foundation P.O.Box 1169, Thimphu Bhutan Phone: +975-17880202 (Tashi), +975-02-351212, +975-17110755 (Lungtaen) Email:[email protected](Tashi), [email protected] (Lungtaen)
China Ms. Shamo Thar (Xia Maotai) Founder and Managing Director Pnetok Institute Room 602, Unit 2, Building 13, Meili Jiayuan, Haihu Road, Xining City, Qinghai Province, China. 8100001 Phone: 86.138.9765.8120 or 86.971.6330.921 Email: [email protected]; or [email protected]
India Ms. Premi Indra Kumar Educational Consultant MLS Trust, Karaikudi, Tamil Nadu - 630 002, India Cell: +91-9486729027, Landline: +91-452-2525172 Email: [email protected]
Nepal Ms. Anjana Shilpakar PAHAL Lagankhel, Lalitpur, Kathmandu, Nepal GPO Box: 1264 Tel: +977-9721340106, +977-9851074119 Email: [email protected]
Pakistan Ms. Nausheen Azam Knowledge Management Office (KMO) NRSP-Institute of Rural Management (N- IRM) House - 6, street 56, F-6/4 Islamabad; Pakistan Cell: +92-334-7078755; E-mail: [email protected]
Sri Lanka Prof. A. Navaratnarajah Consultant/Director, Sewa Lanka Tertiary Education Programme, Sewa Lanka Foundation, No 216/1, Dehiwala Road, Maharagama, Sri Lanka Phone No: +94-11-3166334/5, Mobile:+94-777739261 Fax: +94-11-2850622 E-Mail: [email protected], [email protected]
Afghanistan Md. Shahabuddin Ahmed Program Manager BRAC Afghanistan Education Program BRAC Afghanistan, House # 45, Lane # 4, Bucher street (Kucha e kasabi) Bahrestan (Behind Bahrestan Cinema) Karte Parwan, Kabul Phone: +93-0-700228078 Email: [email protected]
Vietnam Mr.Kim D Nguyen (PhD) Vice Director General Institute for Educational Research HoChiMinh City University of Education 115 Hai Ba Trung St., Dis. 1, Ho Chi Minh City, Vietnam Tel.: 84-8-38277404-38272891-38232317-38224813 (21) Fax: 84-8-38273833 Email: [email protected]; [email protected] Website: http://www.ier.edu.vn; http://ceea.hcmup.edu.v
Cambodia Ms. Chakrya Chea Khem Senior Manager Harpswell Foundation/ Dormitory and Leadership Center For Women Address1: #19, Street 508, Sangkat Phsadeum Thkov, Khan Chamcarmorn, Phnom Penh Address2: #12, Street 13, Village Sleng Roleung, Sangkat Teuk Thla, Khan Sen Sok, Phnom Penh PO.Box:515 H/P:+855 12 549 055 Email: [email protected] Website:www.harpswellfoundation.org
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FINANCIAL AID APPLICATION FORM AUW offers a wide range of financial assistance to qualified students from partial to full scholarships based upon an assessment of the student’s family’s financial situation. Please fill out this form completely in English and provide all supporting documentation. Incomplete forms will not be considered for financial aid. All information provided will be kept strictly confidential.
B. FAMILY INFORMATION 1. Student Name: _________________ ________________________ ____________________
Last First Middle
2.Parental Information: Mother Father a. Living? (Y/N): b. Age: c. Occupation: d. Employer: e. Education level: f. Any disabilities:
3. Dependents: How many people, including yourself, depend on the income of your parents for daily living expenses?
Sibling Name(s) Age Highest Degree Last School Attended Occupation (if any) Other Dependents: (If any) Age Relationship
C. FINANCIAL INFORMATION
4. Total Household Income Please indicate the total household income earned during the last year, including all amounts from the mother and father’s employment, any family business or real estate holdings, savings and investments, and any other sources of income:
USD$
5. Household Expenses How much did your family spend on the following expenses during the last year? a. Rent or mortgage and utilities USD$ b. Educational expenses USD$ c. Food and household necessities USD$ d. Loan payments USD$ e. Medical expenses USD$ f. Other expenses USD$ g. Total expenses during last year: USD$
Admissions Office Asian University for Women 20/G. M.M. Ali Road, Chittagong- 4000 Bangladesh Tel: +880-31-2854980 Direct Phone: +88-0393-0070774 Fax: +880-31-2854988 Email: [email protected] Website: www.asian-university.org
Applicant ID (Official Use Only):
Name:
Country:
US1 = __________ Local Currency
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D. ASSET INFORMATION 6. Does your family own a home? If yes:
Yes
No
a. number of homes owned: b. type of home that you currently reside in: (e.g., inherited, purchased, self-built, thatched cottage, 4-bedroom house, etc.)
c. present value of the home you currently reside in: USD$
7. Do your parents run a family business? If yes: Yes No
a. nature of the business? b. number of employees? c. yearly revenue of the business?
8. Household amenities: a. does your family own a car: b. number of domestic helpers: c. number of computers/laptops: d. number of mobile phones: e. does your family own a washing machine:
E. FAMILY CONTRIBUTION How much do you expect to pay towards your tuition fees and living expenses at AUW? USD$______________
What will be the source of your funds? (Please Tick) Family’s income Family’s assets Relatives & friends Your government Agencies/foundations Private sponsor Others (Please explain) F. DOCUMENTATION 9. Documentation Please attach all available forms of documentation:
a. Income tax certificate indicating tax paid in [2009]: Attached Unavailable or N/A b. Land tax form/rental receipt: Attached Unavailable or N/A c. Employer statement of salary/salary slip: Attached Unavailable or N/A d. Bank Statement for last six months: Attached Unavailable or N/A e. Trade License: Attached Unavailable or N/A f. Community certification for farmers: Attached Unavailable or N/A g. Other: _______________________ Attached Unavailable or N/A
G. CERTIFICATION AND AUTHORIZATION We declare that the information provided on this form is true, correct, and complete. The university has our permission to verify the information reported by obtaining additional documentation as needed. We understand that providing false information may result in revocation of an offer of enrollment or financial aid. X Student’s Signature Date X Mother’s Signature Date X Father’s signature Date
Admissions Office Asian University for Women 20/G M.M. Ali Road Chittagong – 4000, Bangladesh E-mail: [email protected] Web: www.asian-university.org
INSTITUTIONAL RECOMMENDATION
This form should be completed by someone who is able to comment on the applicant's academic ability, such as a teacher who has taught at the institution where the applicant has completed or will complete her higher secondary education.
APPLICANT
Name of Applicant: __________________________________________________________________
Last First Middle
Country: __________________________
TEACHER/HEAD OF THE INSTITUTION
Name: __________________________________________________________________ Last First Middle
Address: ___________________________________________________ Phone number _______________________________
___________________________________________________ Fax number ________________________________
___________________________________________________ E-mail _____________________________________
___________________________________________________
Institution: ________________________________________________________
To the Referee:
The Asian University for Women seeks highly talented students of diverse economic, cultural, religious, ethnic and geographical
backgrounds from across Asia. The University hopes to graduate women who will become skilled and innovative professionals, and
service-oriented leaders in the businesses and communities in which they work and live. The AUW will train and help promising
students with limited economic resources to pursue higher studies at the Asian University for Women. The individual named above is
interested in joining AUW . She has to obtain a reference letter from a teacher or the head of the institution where she has
studied. The applicant has chosen you as the Institutional Referee. You are expected to know the applicant's strengths and weaknesses and
give a balanced view. We will appreciate your answering the questions below in a thoughtful, specific, and candid manner; this will greatly
help us in the admission process. Please enclose the completed form and a reference letter in a sealed envelope and return to the candidate
for submission with her main application form.
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3. Are you a close relative of the applicant? ___ Yes ___ No 4. As far as you know, has the applicant participated in social activities? ___ Yes ___ No If yes, please specify details of any one activity:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
5. How do you rate the applicant with respect to the qualities listed below?
Not sure Inadequate Average Good Outstanding
Aspiration to be an achiever in life:
Ability to take up challenges:
Capacity to solve problems:
Ability to work in a team:
Communication with others:
Adaptability to new situations:
Involvement in social causes:
6. Has the applicant at any time proved herself exceptional in her contribution to the community? Please elaborate your views using
specific case(s). Attach a separate sheet if necessary.
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
7. What are the applicant's major strengths or weaknesses?
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
8. How do you rate the economic status of the applicant's family? ___ Affluent ___ Medium ___ Poor 9. In your opinion, how will it benefit your community if she has the opportunity to study at AUW?
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
10. To what extent would you recommend the applicant for admission to the Asian University for Women?
___ Strongly recommend ___ Recommend ___ Recommend with some reservations ___ Do not recommend Signature of Referee: __________________________________________ Date: ______________________________
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