Office of Admissions

Asian University for Women

20/G. M.M. Ali Road,
Chittagong - 4000 Bangladesh
Tel: +880-31-2854980-87 (Ext. 128,125,165)
+880-31-2865497
Fax: +880-31-2854988
Email: admissions@auw.edu.bd
Website: www.auw.edu.bd

For the Office of Admissions Use Only

Serial No:
Applicant ID:
Country:

APPLICATION FORM
2016-2017
Deadline for Admissions application is February 14, 2016. Short-listed applicants will be invited to sit for an AUW-administered
entrance exam and personal interview.
For the Office of Admissions Use Only
YES

Form complete?

NO

If NO, check any of the following:

Application form

Self Assessment Form

Institutional Recommendation form

YES

Any document missing?

NO

If YES, check any of the following:

Photo

th

10 Grade Result

th

th

11 Grade Result

12 Grade Result

YES

First female graduate in the family?

Please staple here

three (3) passport-sized photos
(white background)
of the applicant.
Please write the applicants name
in capital letters on the back of
each photo.

NO

Exam Center:
Shortlisted Category:

Personal Details
Full Name
(As in the Passport or
Academic Transcript):

Age and Date of birth

________________________________________________________________________________
First Name
Middle Name
Last Name
_____

_____

Age

dd

_____

_____

mm

yyyy

Religion

Languages

Ethnicity

Marital Status

Blood Group

Country of Birth

Country of Citizenship

Personal Contact Details

Applicants Home Phone
Number

Applicants Cell
Phone Number

Applicant Email Address

Applicants Present
Address
City

State/Province

Postal Code

Country

Applicants Permanent
Address
City

State/Province

Postal Code

Country

Family Information
Father

Mother

Full name
Living? (Yes or No)
Parents Age
Education level
Occupation
Home Phone Number
Cell Phone Number
Email Address
Sibling Name(s)

Age

Gender

Occupation

Education Level and Year Completed

Emergency Contact Details

Name
Relation
Address
Home Phone Number

Cell Phone Number

Email Address
How did you learn about the Asian University for Women
Please check all that apply
AUW Students
Country Coordinator
NGO Announcement
Parents/Family member

Flyer
Brochure
Website
Newspaper

Poster
Radio
Television
School Official

Social Media
School Presentation
Others

Academic Performance
th

10 Grade or Equivalent Examination

Name of Institution
Name of the Exam

Year of Exam

Final Result
Marks in %

Grade

Medium of Instruction

English
Mathematics
Other subjects, specify
i.
ii.
iii.
th

th

11 Grade/ 12 grade Test Examination/ AS or Equivalent Examination

Please mention approximate date, when you will sit for the final exam
From ------- /-------- /-------day

month

To ------- /--------- /---------

year

day

month

Estimated Date of publishing final result: ------- /------- /------

year

day

month

year

Name of Institution
Final Result
Marks in %

Grade

Medium of Instruction

English
Mathematics
Other subjects, specify
i.
ii.
iii.
th

12 Grade or Equivalent Examination

Name of Institution
Name of the Exam

Year of Exam:

Final Result
Marks in %

Grade

Medium of Instruction

English
Mathematics
Other subjects, specify
i.
ii.
iii.
Are you currently a student of any other university?
Please mark the box with a cross
Name of the University (if yes):

Yes

No

Scholastic Award (if any)

Year

Description

Achievements
Sports & Culture
Briefly list significant extracurricular and community activities that you have participated in secondary or higher secondary school
(e.g.: sports, dance, music, arts, class monitor, clubs, food relief, local fair, community service, etc.). Please indicate special
distinctions or awards obtained
Activity
Year/Length of Involvement
Awards if any

General
Indicate any leadership positions held:
Position

Field of activity

Majors
What is your intended major(s) or area(s) of interest? Please mark the box with a cross
Economics

Environmental Sciences

Public Health Studies

Politics, Philosophy, & Economics

Possible career interest

Documentation
Supporting Documents (Please attach all the documents below and check the box if you have attached)

Photos (3 copies of passport sized photo, with white background)

th

10 Grade Results (photocopy and attested)

th

11 Grade Results (applicable for 11th Grade/ 12th grade Test / AS or Equivalent
Examinees. Photocopy and attested)
th

12 Grade Results (photocopy and attested)

Attached
Attached
Attached
Attached

Certification and Authorization (Please Read Carefully)

We declare that the information provided in this application form and all of its attachments are true, correct, and complete. The
university has our permission to verify the information reported by obtaining additional documentation as needed. We understand
that providing false information may result in revocation of an offer of enrollment or financial aid.

X
Applicants Signature

Date

X
Mothers Signature

Date

X
Fathers/Guardians signature
4