UNIVERSITY OF NORTHAMPTON USA
Undergraduate Student Admissions Form

APPLICATION FOR UNDERGRADUATE STUDY

By filling out any part of this form the University will retain your data in line with legal requirements or where there is a business need.
Before completing this form you should consult the University’s Undergraduate study’ web pages www.northampton.ac , and your proposed programme of study for further relevant advice and information. Please complete the form legibly.

Refrence no _________________

Personal details

Full Name
Title Mr Ms Miss Mrs Dr
Date of birth
Sex Male Female
Nationality
National ID card No
Date of Issue
Passport No
Date of Issue
Valid until
Issued by

Contact details

Address
Post Code
Tel No
Mobile
WhatsApp
Email

Programme of study details

Title of the Programme
Course in which you wish to study
Location of studies
Start month

Previous education details

Please provide details, including results, of all higher education or professional qualifications you have already taken, or will be taking (starting with the most recent) and attach copies of transcripts or certificates where possible. Include results of any examinations taken as part of any current studies.

Qualification
School / Institution
Class / score / grade / GPA
Date of award
Upload Certificate
Qualification
School / Institution
Class / score / grade / GPA
Date of award
Upload Certificate
Please provide details of any other qualifications you have (i.e. other languages, seminars or courses you have attended, computer skills etc.)

Police Clearence

Conviction: For purpose of this application, the term “Conviction” is defined as being convicted of a crime by (1) entering a plea of guilty, or by (2) entering a plea of no contest, or by (3) being convicted as a result of trial..

Have you ever been arrested and charged for any criminal act? Yes No
Have you served prison sentence for any crime? Yes No
Kindly attach a Police Character Certificate issued in last 30 days?

I declare under penalty of perjury in the second degree that the responses provided in this Criminal History Form and all attachments are true, correct, and complete to the best of my knowledge, that I have read the Applicant Criminal History Form, that I understand all the questions on the Criminal History Form, that I have personal knowledge and that all the Information placed on the Criminal History Form is true and accurate. I also acknowledge that I understand that any incomplete or false statement could be grounds for denial and revocation of my degree/ license application. I agree to conform to all rules and regulations promulgated by the University of Northampton and Licenses, the Code, and with provisions of the Northampton.

Declaration

I certify that the information I have given is complete and accurate. I have read the regulations and the University of Northampton’s financial policies and I agree to abide by the rules.
I authorise the University to use photographs taken from social or other college activities, in which I might appear, for promotional purposes

Signed
Date