Serial No:

Matric No.:

IN T E R N A T IO N A L IS L A M IC U N IV E R S IT Y C H IT T A G O Application Form for Admission

Program: Semester: Spring Summer Autumn Academic Year:
Attach One Stamp Size Photograph

A. PERSONAL DETAILS:
Full Name Fathers Name Mothers Name Guardians Name
( where applicable)

English: Bengali: Occupation: Occupation: Occupation: Month: Year: Marital Status: Single Married Female

Date of Birth: Day: Religion: Nationality:

Sex: Male Passport No. (if any):

Present Address:

Permanent Address (if different)

Tel: Fax: Examination/ Degree

Mobile (if any): E-mail: University/Board/ Institution

Tel: Fax: Group / Discipline

Mobile (if any): E-mail: Year of Passing Class/Grade / division/ Marks Obtained

B. ACADEMIC BACKGROUND:

C. PROGRAM OF STUDY APPLIED FOR :(in respect of preference)

1st Choice : 2nd Choice :

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D. PROFESSIONAL DEGREE/DIPLOMA/TRAINING (if applicable):
Name of awarding institution / body Field/Subject(s) attended Degree/Diploma obtained Grade

E.

EMPLOYMENT RECORDS (if applicable):

Name and address of employer Date of employment Position held Responsibilities

F. LANGUAGE PROFICIENCY :
Excellent
(Tick mark where applicable)

Very Good English

Good Arabic

Fair English Arabic

Skills

English

Arabic

Arabic English

Reading Writing Speaking Understanding

G. FINANCIAL INFORMATION : Source of financial support: a. b. c. Self Fathers/Guardians Sponsors

Personal income (per annum): Fathers/Guardians income (per annum) : Sponsor: i) Name of the Sponsor: ii) Amount sponsored:

H. REFEREES:
Please give names of two persons who are able to comment on your ability and aptitude for your chosen program of study in the University. 1. Name:... Position: Address: .. . Tel: E-mail: 2. Name:---------------------------------------Position:------------------------------------Address:------------------------------------... ... Tel:------------------------------------------E-mail:

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I. OTHERS:
Do you need the University residential facilities? Yes No If yes; please report to the Students Affairs Division (STAD) of IIUC for necessary arrangement.

J.

DECLARATION:
I do hereby certify that the information provided in this application, are complete and true. I understand that the University has the right to reject this application or cancel my admission if any information provided herein is found false or incorrect. If my application is accepted for admission to the program applied for, I undertake to abide by all the rules and regulations of this University and ensure to pay all fees & charges duly. Date: Applicants Signature

K.

CERTIFICATION BY FATHER/GUARDIAN /SPONSOR (as the case may be): I hereby certify that all the information furnished in this application are complete and true. I understand that if at any time the information or part thereof stated in the declaration is found to be otherwise, the University has the right to disqualify this application or cancel his/her admission. I also hereby declare that I take the full responsibility to bear the expenses to his / her studies at IIUC. Date: Signature of Father/Guardian/ Sponsor
(The Candidate must enclose the following documents with the Admission Form)

Enclosures:

1. Attested true copies of all academic Certificates and Marks Sheet 2. Two copies of stamp size photographs

N.B: Incomplete application will not be considered for admission. (Perforation............................................................................................................................)

International Islamic University Chittagong Attach A Stamp size Photograph Admit Card
Semester: Spring Summer Autumn Academic Year: Roll No....................................... Program:.............................................................................. Applicants Name:................................................................................................................................... Date of Admission Test: ............................................................. Time:..................................... Contact Address:......................................................................................................................................
Authorized Signature

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FOR OFFICIAL USE ONLY

Academic Affairs Division:

Application Form:
Remarks (if any): Authorized Signature of ACAD

Departmental Remarks:
Incomplete Recommended Not Recommended

Complete

Signature of the Head of the Department

Final Approval:
Accepted Remarks (if any): Date: Signature of the Pro Vice-Chancellor

Rejected

Instructions 1. The Candidate must carry the Admit Card during the Admission Test and Viva Voce. 2. It is not transferable. 3. If it is lost before Examination, Please report at ACAD of IIUC immediately.
Academic Affairs Division Permanent Campus: Kumira, Chittagong Chittagong City: 154/A, College Road, Chittagong- 4203, Bangladesh.
Phone: 88-031-610085, 610308, 638657, 617347 Fax: 610307 E-mail: acad@iiuc.ac.bd, Web site: www.iiuc.ac.bd

Dhaka Campus: House# 23, Road # 3, Dhanmondi, Dhaka-1205, Bangladesh. Phone: 88-02-9670220, 8629947, 9670193, 8613294, Fax :8624692,. E-mail: iiuc_acad@yahoo.com