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Online Application Form

Fill out completely the information below, in order to apply online, provide all the information because this will help us to evaluate your potential and ability and the man behind the applications. Please allow us minimum of two weeks to respond to you because the eligibility committee will process all your applications. akku legend bb00100

All Sections of this form must be completed and an attachment must be sent via surface mail in order to validate this application with:

Official Transcripts from educational Institutions Attended
Full Resume/Curriculum vitae
Two References
Self assessment / auto biography
Four (4) recent passport size photographs
Application Process Fee
Other Relevant information/documentation (e.g. Requests for exemptions, financial aid)

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I am applying for

Associate Degree Bachelors Degree Masters Degree Doctoral Degree

IN

Date of proposed enrolment

Fall 2003 Winter 2003 Spring 2003 Summer 2003

Part I: Personal Information

Full Name

First Name Middle Name Last Name

Permanent Address: Address line No.1

Address line No. 2

Address Line No.3

(your email address)

State/Province

City Country

Telephone: (Office)

(Home) Any other Specify

Date of birth:

Date Month Year

Place of birth

(If you are now away from country of residence) City Country

Racial Background:

Marital Status: Nationality

Part II: Education

University Education

If you have more than three degrees/diplomas, please provide only the relevant/important ones.

University Education 1 Name of the University/college/Institution

(If any) Diploma/Degree Attained

Year From dd/mm/yy to dd/mm/yy

University Education 2 Name of the University/college/Institution

(If any) Diploma/Degree Attained

Year From dd/mm/yy to dd/mm/yy

University Education 3 Name of the University/college/Institution

(If any) Diploma/Degree Attained

Year From dd/mm/yy to dd/mm/yy

High School Name of High School Attended

Education: Diploma Attained

(Most Recent One) Year From dd/mm/yy to dd/mm/yy

Certifications Received/Honors Awarded:

If you have more than three certifications, please provide only the relevant/important ones.

Certification 1 Name of the University/college/Institution

(If any) Diploma/Degree Attained

Year From dd/mm/yy to dd/mm/yy

Certification 2 Name of the University/college/Institution

(If any) Diploma/Degree Attained

Year From dd/mm/yy to dd/mm/yy

Certification 3 Name of the University/college/Institution

(If any) Diploma/Degree Attained

Year From dd/mm/yy to dd/mm/yy

Part III: Work Experience

Work Experience (1) (If any) Name of the Institution

Job Title

Year From dd/mm/yy to dd/mm/yy

Work Experience (2) (If any) Name of the Institution

Job Title

Year From dd/mm/yy to dd/mm/yy

Work Experience (3) (If any) Name of the Institution

Job Title

Year From dd/mm/yy to dd/mm/yy

Please make sure that the job experience should not include experiences acquired for less then two months full time and two years as part time. If you have worked for more than three companies fitting to the criteria mentioned above please fill down only the most

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recent/important/relative to the field of study that you have chosen above

Part IV: Financial Matters

Who will be responsible for your fees?

Invoice Details to

Part V Languages

Rate the languages you know and rate your proficiency as follows F= Fluent M= Moderate m= minimal

Language Speaking writing Reading Listening

1. Language a

2. Language b

3. Language c

If English is not your first language, was it the medium of instruction in your high school/college/ university?

Yes No

Have you sat for any of the following English proficiency Exams?

ILETS TOEFL Other

Part VI: Your Health

Your Health

Please list any physical handicaps:

Are you under a physician’s care?

Yes No

Have you been under medical care for extended periods?

Yes No

Has your education been interrupted by illness?

Yes No

What is Your Height Your weight?

Part VII Exemptions Credits, Advance Placement

Are you seeking credit/exemption/advanced placement for previous tertiary study?

Yes No

If yes please provide full details (I.e.; complete course outlines for each subject and verified transcript (s). this issue should be settled before you begin the PIU program. Exemptions/credits/advanced placement will not be granted after you have formally enrolled.

Part VIII: Beyond the Program

How did you find out about Pacific International University? Please be Specific.

What made you decide to apply for a PIU Program?

Have you ever studied or applied for any other PIU Program? Please list them below:

Name Dates of Study Program Relationship

What part of the PIU vision appeals to you most?

What PIU areas can you contribute to?

Are you willing to be active in the PIU worldwide alumni association?

Yes No

Part IX Self Evaluation

What are your non-academic interests?

What do you hope to achieve by and benefit from doing this program?

What do you think are your major strengths and weaknesses?

Can you work well in teams?

Yes No.

If yes how? If no, why not?

What are your biggest accomplishments to date? Why?

Notes:

Your application will not be processed unless it is complete and all relevant documentation submitted

· A non-refundable application fee is required

· Two references attesting to your unique qualities, motivation and ability for completing the program must be submitted

· You must get a university seat within three months in written form

· If seat could not be found within the time mentioned just above a new application must be submitted for reconsideration.

· Other information will be provided after enrolment.

Part X References:

Please Type in name and other field labels mentioned below in order to locate your references

Name / Title/ Institution Name/ Address-surface mail/ E-mail

Students Declaration

IMPORTANT: THIS APPLICATION WILL NOT BE PROCESSED IF THIS FORM IS NOT READ, UNDERSTOOD AND ACCEPTED

I CERTIFY THAT THE INFORMATION CONTAINED HEREIN IS COMPLETE AND ACCURATE TO THE BEST KNOWLEDGE

I UNDERSTAND THAT THE APPLICATION PROCESS FEE IS NON REFUNDABLE.

I UNDERSTAND THAT IT IS MY RESPONSIBILITY TO OBTAIN THE RELEVANT DOCUMENTATION REQUESTED BY PACIFIC INTERNATIONAL UNIVERSITY AND AUTHORIZE PACIFIC INTERNATIONAL UNIVERSITY WHERE NECESSARY TO OBTAIN FURTHER INFORMATION FROM THE APPROPRIATE EDUCATIONAL INSTITUTIONS.

I UNDERSTAND THAT THIS INFORMATION WILL BE RETAINED ON A DATA BASE FOR ADMINISTRATIVE AND REGULATORY PURPOSES.

I UNDERSTAND THAT PIU MAY USE MY ¨PHOTO AND NAME FO THE NEWS ITEMS, ADVERTISING AND PUBLICITY FOR PIU AND ITS PROGRAMS.

I UNDERSTAND THAT PIU RESERVES THE RIGHT TO CHANGE ANY PROVISION OR REQUIREMENT AT ANY TIME, EVEN WITHIN A STUDENT’S TERM OF EMPLOYMENT AND THAT THE UNIVERSITY FURTHER RESERVES THE RIGHT TO ASK ANY STUDENT TO WITHDRAW FOR ANY DUE CAUSE AT ANY TIME.

I UNDERSTAND THAT PIU RESERVES THE RIGHT TO MODIFY ITS FEES, TO ADD OR WITHDRAW MEMBERS FORM ITS FACULTY OR ADMINISTRATION, AND TO ARRANGE ITS COURSES, PROGRAM, AND FACILITIES AS TEACHING AND ECONOMIC EXIGENCIES RENDER IT DESIRABLE.

I UNDERSTAND THAT THE ADMISSION TO PIU IS CONDITIONAL UPON MY ACCEPTANCE AND COMPLIANCE WITH THE RULES AND REGULATIONS OF THE UNIVERSITY AS NOW ESTABLISHED OR HEREAFTER REVISED.

I UNDERSTAND THAT PIU CONSISTS OF AN INTERNATIONAL CONSORTIUM OF INDEPENDENT INSTITUTION S, AND IS DEFINED BY ITS CHARTER AS A GLOBAL UNIVERSITY FREE FROM NATIONAL LIMITATIONS-IT IS NOT AN AMERICAN, BRITISH, IRISH, OR OTHERWISE UNIVERSITY.

I AGREE TO ABIDE BY THE RULES AND REGULATIONS OF PACIFIC INTERNATIONAL UNIVERSITY.

I HAVE COMPLETED THE FORM ABOVE AND SUBMIT IT WITH ACCEPTANCE