Student Application

Section A: Your Application (PLEASE FILL IN BLOCK LETTERS)

You must submit a copy of the personal details page of your Passport / NIC

Nationality

0 / 25

Country of Residence

NIC / Passport No

0 / 25

Date of Expiry

For Non Sri Lankan Passport Holders :

Current Visa Status

0 / 25

Date of Expiry

Section B : Personal Details

You must submit a copy of the personal details page of your Passport / NIC

Title

First Name

Middle Name

Last Name

Name to be used for correspondence *

Date of Birth

Gender

Land Phone No.

Mobile Phone No.

Email Address *

Section C : Personal Details

Do you have any disability, impairement or long - term medical condition that may affect your studies?YesNo

if yes, please specify

Do you need support due to a special needs requirement, physical or medical?YesNo

if yes, please specify

Significant Medical Information0 / 180

Blood Group

Do you have any criminal convictions

if yes, please specify

Section D : In Case of an Emergency

First Name

Last Name

Land Phone No.

Mobile Phone No.

Relationship

Section E : Secondary School Education

Secondary school educationGCSE (SL)CIEEDEXCELOTHER

Year

Examination body

School

Subjects

Result

Section F : Academic Qualifications

Please refer to the details in the Undergraduate Prospectus for any additional requirements and prerequisites. Include details of your previous academic qualifications & dates of commencement and completion; if you are yet to finish studies please indicate your intended completion date. Certified copies of academic qualifications must be attached to this application. If the qualifications are in a language other than English, please also supply certified translated copies.

Name of Qualifications

Institution

Awarding Body

Country

Date Commenced

Date Completed

Name of Qualifications

Institution

Awarding Body

Country

Date Commenced

Date Completed

Other Qualifications

Please select whether ( YES ) or ( NO )YesNo

If yes, please specfify

Section G : English Language Proficiency

Please tick the appropriate box, if you have sat for any of the following exams which have been conducted in English medium.

Please tick the appropriate box.GCSE / Edexcel / CIEIELTSGCSE A/LTOEFLYou must provide proof of your English Proficiency to the required standard of your chosen course by providing the necessary certified document. If you do not meet the course English requirements, you may be required to complete an English Language Proficiency Test.

Section H : Work Experience and Employment Details

Please give details of any work experience and training.You may continue on a seperate sheet of paper if necessary.

Please click if ( YES ) or ( NO )

Name of Organization

Job title and Nature of Work / Training

Please click the appropriate

From

Section I : Course Preference

Refer to the Postgraduate Prospectus for details of the course code, titles and start dates. You may check the entry requirements and prerequisites for each course to see if you qualify

Course Name

Study ModeFull TimePart Time

Course Code

Date

Commencement Year

Intake

Batch Code

Section J : Application Fee Payment

Registration Fee

Invoice No

Preferred Payment PlanFull PaymentBank LoanSpecial Payment PlanInstallment Scheme

Section K : Further Information

If other or through a friend , please specify

Section L : Privacy and Student Declaration *

IMPORTANT NOTE

Global Technological Campus (GTC) aims to ensure that quality of educational services is upheld, as stated in the Academic Policy, to the maximum possible degree. If external circumstances interfere with the educational process, GTC will take all reasonable steps to minimize any disruption to academics. In addition, GTC will not take responsibility for any actions or circumstances which may be directly or indirectly outside the control of GTC.

GENERAL PRIVACY STATEMENT

The information collected on this form is solely used for academic purposes. It is used to assess your application for entry to the course offered at GTC. It will also be used to create an enrollment record on the student database, for statistical analysis and to inform you about your course and other related events. Personal information may be collected from, or disclosed to, relevant bodies for the verification of previous qualifications, and it may be disclosed to the relevant government agencies, as required by law.

STUDENT DECLARATION

I warrant that the information on this form is current and complete. I acknowledge that the provision of incorrect information or the withholding of relevant information relating to my application, including academic transcript/s, might invalidate my application and that GTC may withdraw an offer of a place or cancel my enrollment in consequence.

Section A: Your Application (PLEASE FILL IN BLOCK LETTERS)

You must submit a copy of the personal details page of your Passport / NIC

For Non Sri Lankan Passport Holders :

Section B : Personal Details

You must submit a copy of the personal details page of your Passport / NIC

Section C : Personal Details

Section D : In Case of an Emergency

Section E : Secondary School Education

Section F : Academic Qualifications

Other Qualifications

Section G : English Language Proficiency

Please tick the appropriate box, if you have sat for any of the following exams which have been conducted in English medium.

Section H : Work Experience and Employment Details

Please give details of any work experience and training.You may continue on a seperate sheet of paper if necessary.

Section I : Course Preference

Refer to the Postgraduate Prospectus for details of the course code, titles and start dates. You may check the entry requirements and prerequisites for each course to see if you qualify

Section J : Application Fee Payment

Section K : Further Information

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