Application Form For Galen

GALEN UNIVERSITY APPLICATION FOR ADMISSION Please complete and return the completed application form and additional documents to the Office of Admissions, Galen University, P. O. Box 177, San Ignacio, Cayo, Belize. Attach a check or money order for $60 BZD or $30 USD payable to Galen University. This fee is non refundable. Attach 2 recent passport size photographs. _____________________________________________________________________________ _ Galen University is committed to the principles of equal opportunity in education. The University does not discriminate against individuals on the basis of race, color, sex, sexual orientation, religion, disability, age, ancestry, or national or ethnic origin in the administration of its educational policies, admission policies, employment policies, and other University administered programs and activities. NAME: _____________________________________________________________________ Last

First

I am entering as:

Undergraduate Full-time Day

For which program:

Middle

Undergraduate-Transfer Graduate Part-time Evening Weekend

_______________________________________

In the following term:

Spring 2008 Summer 2008 Session II

Summer 2008 Session I Fall 2008

_____________________________________________________________________________

FOR OFFICIAL USE ONLY – Please do not write in this section Amount

Receipt No.

Date

Application Fee Credit Eval. Fee Tuition Deposit

________ ________ ________

__________ __________ __________

_________ _________ _________

High School Grade Student Number

_________________ Admission Status _________________ _________________

I. PERSONAL DATA Permanent Home Address ________________________________________________________ Permanent Email __________________@______________ Telephone:____________________ Social Security Number /Other National I.D.# ____________________________________ Date of birth __________________ Place of Birth ______________________________ Sex: Female

Male

Nationality_________________________________

Country of Residence _________________ Country of Origin _____________________ Primary language ____________________ Language spoken at home ________________

II. EDUCATIONAL DATA Please list in chronological order (starting from most recent) all schools (Secondary, College, University) you have attended or are currently attending. An official or certified/attested English translation of certificates, diplomas, degrees, transcripts (marksheets) or any other supporting documents must accompany this application or be received before your application will be considered. Academic Record (A official transcript must be received from each institution prior to Admissions Committee Review)

Institution Attended*

Dates

Location City & Country

Major

Degree(s) earned

*All foreign transcripts must be evaluated, on a course-by-course basis.

III. EVIDENCE OF PROFICIENCY IN ENGLISH Please indicate if you have ever taken any English examinations (such as TOEFL, GCE/GCSE, IELTS). Attested copies of official results must be supplied, and either accompany this application or be forwarded as soon as received. Examination taken: ____________________ Result____________________ Date___________

Examination taken: ____________________ Result____________________ Date___________ IV. OTHER QUALIFICATIONS Please list any other qualifications (GCE, LCCI, etc.) obtained by examination. Certified/attested copies of official results must accompany this application. Subjec

Board or Examining Body

Grade/Result

Examination Date

t

V. APPLICATION INFORMATION Please indicate the source (s) and reason(s) that led you to apply to Galen University. Sources Reasons High School Counselor/Teacher Reputation Friends Possibilities to transfer to U.S.A./U.K. Galen University student or graduate Qualifications to be attained Advertisement:_________________ Reasonable tuition and fees Internet/Website Safety/Security Education Fair Other:_________________________ Other:________________________ VI. CERTIFICATION I have read, understand and agree to comply with Galen University application instructions. I certify that the information in this application and associated materials is current, complete, and accurate to the best of my knowledge. I understand that withholding information requested in the application or giving false information may make me ineligible for admission to or continuation in Galen University. Applicant’s signature____________________________ Date:___________________________ VII. PAYMENT I am paying my application fee (US$ 30):

cash (on site only) by check enclosed by money order by credit card (please fill the section hereunder)

Credit card type: Visa Mastercard Am. Express Discover Name on the card: _____________________________________ Card Number__________/__________/__________/__________ Exp. Date: ______/______ Signature of the card holder ________________________ Date:_________________________

You are required to submit the following items in order to apply for admission: 1. The Application Form Complete this form and submit it with a nonrefundable fee of $60BZD or $30 USD. 2. Photographs Enclose two (2) recent passport-size photographs. 3. Academic Records Enclose official or certified/attested English translation of: • High (secondary) School Leaving Certificate, or equivalent for undergraduate studies • Bachelor’s degree, or equivalent qualification, for graduate studies 4. Other Qualifications Enclose other official or certified certificates or examination results 5. Transfer Students Applicants who wish Galen Univ. to accept transfer work completed at other colleges/universities must submit official transcripts and course descriptions of syllabi in English. The above must be accompanied by a non-refundable Credit Evaluation Fee of $60 BZD or $30 USD. This amount is in addition to the Application Fee. 6. English Language Proficiency Test All students whose secondary or post-secondary schooling was conducted in a language other than English, must enclose official results of TOEFL, GCE/GCSE ‘0’ Level English or IELTS.

IMPORTANT NOTE The Office of Admissions will not process any Application for Admission unless all required documents, as listed above, are submitted. English is the language of instruction at Galen University. All applicants are required to take the Galen University English Placement Test (EPT), which will determine the level of English they will enter and the number of other courses they will be able to take.

CHECKLIST Please ensure that all documents listed below are attached to this form: Application Fee ($60 BZD or $30 USD) Passport photos (2) Transcripts (high school and/or university) Bachelor’s degree English Language Proficiency Evidence

International Students Only Bank Statement of Financial Support Copy of Passport

Graduate Students Only Reference Letters (2)

FOR INTERNATIONAL STUDENTS 7. Bank Statement of Financial Support Enclose an original Bank Statement of Financial Support indicating that your financial sponsor (i.e. only next of kin) has the ability to finance your tuition and living expenses for the academic year. The bank statement must clearly state your name. 8. Passport Copies Enclose copies of all pages (even blank one) of your passport. The expiration date of your passport must be at least one year in the future.

FOR GRADUATE STUDENTS 9. Letters of Reference Enclose two (2) letters of reference from professors familiar with your work.

This application will become a part of your permanent record at Galen University. It should be completed and returned with all necessary documents to: The Office of Admissions GALEN UNIVERSITY P. O. Box 177 San Ignacio, Cayo Belize For information please phone, fax or email: Tel: + 501-824-3226 Fax: +501-824-3723 Email: [email protected] Website: www.galen.edu.bz