emba adm form

Test Pass No ______________

APPLICATION FOR ADMISSIONNorth South University (NSU) is committed to the principles of equal opportunity and is open to all candidates with required academic qualifications. There will be no discrimination on the basis of age, race, sex, religion, nationality, social groupings, etc.

Please cross mark (x) the appropriate boxes, where necessary:

Application for admission in: Spring (Jan – Apr) Summer (May – Aug)

Fall (Sep – Dec) Year

1. Name (in block letters):

_____________ ______________ ____________ _____________First Name Middle Name Last Name Other Name

Date of Birth _______ _________ ______ ______________ ___________Day Month Year Place of Birth Citizenship

Male Female Married Single

2. Information about father/husband:

(a) Name: ________________________________________________________________________________

(b) Occupation & Position: __________________________________________________________________

(c) Work address: _________________________________________________________________________

_________________________________________________________________________

(d) Telephone: ______________________ ______________________ ______________________Home Office Mobile

INSTRUCTIONSa. The application processing fee of Tk.1000 (US $15.00 for overseas applicants) is nonrefundable. The final

decision regarding admissions will be based on the candidate’s academic background and performance in the admission test/interview. The decision of the EMBA Admission Committee shall be final.

b. Applications will not be processed without a Complete Application Package which includes (1) completed application form, (2) three passport size photographs of the applicant, (3) one set of all certificates and mark sheets/ transcripts (attested), (4) one set of appointment letters and experience certificates (attested), and (5) visiting cards of the candidate and the supervisor.

Do not write in this area

Degree

Non-Degree

Accepted conditionally

North South UniversitySchool of Business

Executive MBA Program Plot 15, Block B, Bashundhara, Dhaka-1229, Bangladesh. Tel: 8852000, Fax: 8852016

Please affix two passport

size photographs

here

Not acceptable

3. Mother’s Name: ___________________________________________________________________________

Mother’s Occupation & Position: ______________________________________________________________

4. Mailing Address:

_____________________________________________________ _______________________________House / Apt # Street/Road Village & P.S.

_____________________________________________________ _______________________________District/City Post Code Country

5. Permanent Address:

_____________________________________________________ _______________________________House / Apt # Street/Road Village & P.S.

_____________________________________________________ _______________________________District/City Post Code Country

6. Office / Business Address: ___________________________________________________________________

_________________________________________________________________________________________

7. Telephone: ______________________ ______________________ ______________________Home Office Mobile

Fax : ______________________________ E-mail : _____________________________

8. List the schools, colleges and universities you attended (begin with most recent degree):

Degree / Exam Name of Institution

Board/University/ Country

Year of Passing

Group / Major Area

Class / Division/ CGPA

9. Are you a Dependent? Yes No

Who will pay your tuition and fees? Self Company

Parents/Spouse Other

If Other, please give details below:

Name: ___________________________________________________________________________________

Mailing Address: ___________________________________________________________________________

_________________________________________________________________________________________

Telephone: ______________________ ______________________ ______________________Home Office Mobile

Fax: ______________________________ E-mail: ____________________________________

Relationship with sponsor: ___________________________________________________________________

10. Work Experience (begin with most current job):

Organization & Address Position/Title Supervisor’s Name & Telephone

Dates(From – To)

11. Have you ever been dismissed, suspended or expelled from any academic institution?

Yes No If yes, describe briefly or attach a statement.

12. Were you admitted into any academic program of NSU before? Yes NoIf yes, state ID# and date of admission.

13. I hereby accept that if admitted to North South University, I will be bound by the rules and regulations of the university and the NSU Student Code of Conduct.

I accept that manufacture, distribution, possession and consumption of tobacco products, alcohol, drugs and controlled substances are strictly prohibited in NSU premises and that I may be expelled for violating this rule or for abetting violators.

I agree that withholding information requested in this application or giving false information will make me ineligible for admission into NSU and liable to be dismissed if admitted. I hereby certify that the above statements are correct and complete to the best of my knowledge.

_____________________ _____________________________Date Signature of Applicant

Note: The application will not be processed unless signed.

Date of admission test /interview: Test Pass No. ________________

Please complete the following:

Name: __________________________________________________________

Address: ________________________________________________________

________________________________________________________________

Phone: ___________________________________________________________

Please affix a passport

size photograph

here

emba adm form

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