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Personal Details

Surname / Family Name (As per your ID or Passport)*

First Name(s) (As per your ID or Passport)*

Email*

Permanent Address*

Postcode*

Country*

Contact Numbers (include International Dialing Code)

Phone Number*

Mobile Number*

Fax

Correspondence Address (if different)

Postcode Correspondence

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Further Details

Age

Gender*

Male
Female
Other

Date of Birth*

Cypriot I.D. No. /Passport No.

Disability/Special needs*

Country of permanent residence*

EU
Non-EU
If Non-EU Specify

If Non-EU Specify

Country of Birth

Nationality*

Do you need Entry Permit (Entry Visa)?*

Yes
No

Do you need a change in your current status in Cyprus?*

Yes
No

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Details of course for which you wish to apply

Level of course you are applying for*

Undergraduate
Point of Entry - Year 2
Point of Entry - Year 3
Postgraduate

Full Course Title 1st choice*

Full Course Title 2nd choice

Academic Year*

Mode of study*

Full-Time
Part-Time

Academic Semester*

Fall
Spring

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Please provide full details of educational background including institution name and dates attended, qualifications obtained, subjects and grades. Please attach photocopies of transcripts or certificates if available

Secondary Education

Name of High School

Dates attended From (month & year)

Dates attended To (month & year)

Qualifications

Attach your Photocopies

Higher Education

Name of Institution

Dates attended From (month & year)

Dates attended To (month & year)

Qualifications

Attach your Photocopies

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If your first language is not english, please state which qualifications (e.g GCSE, IELTS, TOEFL) in english language you hold or are currenty studying, the score or grade if known and date taken. Please attach a photocopy of transcript or certificate if available

Qualification

Score or Grade

Date taken

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Please indicate your employment experience including any details relevant to the course for which you are applying.

Employer

Name

Address

Nature of work

Full-time / Part-time

Dates

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Declaration

I confirm

I have read and understood

References

Applies only for postgraduate applications, postgraduate applications require two references.

Statement by Referees – Referees can be asked to supply their references to us in sealed envelopes.

Please return to:
UCLan Cyprus -ADMISSIONS OFFICE
12-14 University Avenue
Pyla, 7080 Larnaka, Cyprus
or P.O. Box 40724, CY – 6306 Larnaka
or via email to: admissions:uclancyprus.ac.cy

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