2014 degree application form - Divine Word University

Divine Word UniversityP O Box 483, MadangTel: 422 2937/422 2597Do not fax in this form!Application Form forDegree StudiesPART 1: PERSONALName:____________________________________________________________(Family or Legal)(Other)_________________________(Christian or given names)Date of Birth:_____ /_____ / _______day month yearReligion: ____________________________________Home Village / Town :______________________ District:________________Province: ______________________Marital Status:No. of Children _________Address Nov 2013 – Jan 2014:_______________________________________________________________________________________________Tel: ____________________ Fax: _________________________e-mail: __________________________DWU does not provide married student accommodation.***************************************************************************************PART 2: EDUCATION, TRAINING AND EMPLOYMENTPlease provide past-DWU transcripts. All applicants must attach all academic transcripts - seniorhigh school, university, etc.The documents must be certified as true copies of the original by a Commissioner of Oaths, Justiceof Peace, a practising Lawyer or a Magistrate at the Court House. Any documentation notproperly certified by one of the above means your application will not be processed.APPLICATIONS WITHOUT REFERENCES WILL NOT BE PROCESSED.Applying for Degree studies in(tick one)Journalism Arts (PNG Studies) Arts (Social and Religious StudiesHealth Management Environmental Health Rural Health (HEO)Physiotherapy Accountancy ManagementTourism & Hospitality Information Systems Mathematics &ManagementComputer ScienceI completed my DWU Diploma in the Department of_______________________________________in __________ (year)OR1

I completed a university diploma in___________________________ at _______________________ in _________(field of studies) (University) (year)Employment:_________________________________________ ___________________ ______________________(present employer) (dates) (position)_________________________________________ ___________________ ______________________(previous employer) (dates) (position)Signature of Applicant: _________________________________________Date: ________/_______/__________********************************************************************************PART 3: REFERENCESA) PRESENT EMPLOYER'S REFERENCE: you must attach a reference from your presentemployer concerning your work duties/performance, your acceptance of job related responsibilities,your demonstrated behaviour/character both on and off the job, and your employer's perception ofyour commitment to becoming a professional in your field.B) COMMUNITY OR RELIGIOUS LEADER’S COMMENTS: on the applicant'sinvolvement in the local church and witness to faith.Name______________________Signature:_____________________Parish/Area :__________________________2

1.2.3 Attachment to the application for Degree studies at Divine WordUniversity in 2014.You need to document your efforts at finding Sponsorship for your degree studies. The Fees for Divine Word Universityfor 2011 is K17,000.00. This fee may be subject to change in 2014.Name __________________________________________________________________________________________1. I the undersigned applicant, am willing to pay the whole costs of my schooling (K17,000.00) as a personalpayment.__________________________________________(signature)_____/_____/______(date)2. Sponsorshipi. I have asked sponsorship from my employer, as authorised here:( ) My department / company is willing to provide a sponsorship of K17,000.00( ) My department / company is willing to provide a sponsorship of K______________( ) My department / company will not be providing a sponsorship to the student.ii. Other:_______________________ please indicate.Name: ________________________________ Signature: _________________________________/_____/_____(date)Company / Department __________________________________Position: ______________________________3. I now ask for DWU Shortfall Assistance of K 9500.00 in order to complete the cost of my education.I agree to pay minimum fees of K7590.00DWU Shortfall Assistance asked for (maximum K4750.00 per semester) K9500.00Total feesK17,000.00________________________________________________________________________(signature)_____/_____/_____(date)This fee is subject to change without notice.Degree Applications must be returned by 31 st August 2013. (It is possible to get an earlier reply.)A non-refundable deposit of K50.00 deposit slip must accompany degree Application Form. If there is no evidence ofK50.00 being paid this will result in the application not being assessed. This deposit is to be paid into the DWU BSPA/c No. 1000 433806 and the receipt should be attached to this application.Return this form to: The RegistrarDivine Word UniversityP O Box 483Madang.3