Agora Admission Application

Section I: General Information

First Name *

Last Name *

Birthdate *

Home Phone

Mobile *

Email Address *

Nationality *

Address *

Primary Address City *

Primary Address State *

Primary Address Country *

Disability

Passport *

Resume *

Passport Number *

Name on Passport *

Personal Photo *

Age *

Clergy

Tradition *

Native Language *

Academic Writing Sample

Personal Statement *

Section II: English and Testing Requirements

ESL Certificate

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Section III: Educational Background

University (Undergraduate) *

Major or Specialization (Undergraduate)

GPA (Undergraduate)

Minor (Undergraduate)

Certificate (Undergraduate) *

Graduation Date(Undergraduate) *

Transcript (Undergraduate) *

Other Degrees

Major or Specialization (Other Degrees)

GPA (Other Degrees)

Minor (Other Degrees)

Certificate (Other Degrees)

Graduation Date (Other Degrees)

Transcript (Other Degrees)

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Section IV: Employment Information

Company Name *

Current Position *

Job Start Date *

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Section V: Program

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Section VI: References

Reference 1 Name *

Reference 2 Name *

Reference 1 Email *

Reference 2 Email *

Reference 1 Letter *

Reference 2 Letter *

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Section VII: Scholarship

Are you interested in applying for Scholarship?

Yes

Residents details

Country of Permanent Residence *

Country of Birth *

Employment Information

Gross Monthly Income *

Copy of last three pay slips or HR Letter *

How would you finance the non-scholarship element of your program fees? *

Please detail below how you intend to fund the balance of the program fees *

Do you have children/adults who rely on your income for support? *

Reference

Please provide reference as to character, conduct and eligibility for this scholarship. Cannot be a family member. Please attach letter to this application.

Referee's Name *

Referee's Occupation *

Referee's Phone Number *

Referee's Email Address *

Scholarship Application History

Have you ever been admitted at Agora University before? *

If yes, please provide program name, year, and reason for not joining the program

Have you ever applied for a scholarship with Agora University before? *

If yes, which scholarship, year it was offered, and if you completed the program.

Declaration

I hereby declare that the information contained in this form of application are correct and I confirm that i will notify Agora Univeristy of any changes.

I also understand that the scholarship award decision is at the sole discretion of Agora Univeristy and that there is no right of appeal.

I confirm that I would be happy to be contacted by Agora Univeristy for an interview if required.

By signing your name electronically on this form, You are agreeing that your electronic signature is the legal equivalent of your manual signature on this form. *

Signature *

Date *