Last Name |
First |
E-Mail Address |
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Citizenship |
Current Adress |
Permanent Address |
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Telephone |
Telephone |
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| Veteran:
YES
NO |
Social Security Number |
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Date of Birth |
Place of Birth |
Marital Status |
Passport Number |
Date of issue |
End Date of Validity |
If employed, Occupation |
Employed by |
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| College & University Studies |
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1. Institution
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Adress
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2. Institution
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Adress
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3. Institution
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Adress
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Proposed entrance date |
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Proposed academic area |
Proposed degree |
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Pubblications, if any: |
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| In compiliance with Title Six of the U.S.
Federal Civil Rights Act of 1964, Please check the appropriate
BOX : |
Black
Native American
Asian American
White
Spanish Surname
Other |
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| Health |
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| Are there any conditions of your present physical
or mental health that you feel we should be aware of in
considering your application ? (if "YES",
please descrive on a separate attachment.) |
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| Emergency Information |
| In the unlikely event that you are hospitalized
or in an accident abroad, whom, do you want notified ? |
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Name |
Home Address and Phone |
Relationship |
Work adress |
Work Phone |
Usual Working Hours |
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| Supporting Materials : |
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| 1. Official transcripts from
each institution higher learning you have attended, officially
certified copies of your diplomas and other academic records.
Please have all academic record sent to: UNIVERSITY OF ECOFORUM
FOR PEACE, Office of the Scientific Counselor, Via Foletti
20, 6900 Lugano-Massagno (Switzerland) |
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| 2. At least two references
from individuals with recent knowledge of your academic
capacities and professional experience. Please list below
the individuals you have asked to write us: |
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| 3. A biographical statement
designed to help the admissions committee get to know you
and your goals, and, if you are accepted, to serve as the
beginning of your degree planning process. Please tell us
about your background and about the kind of academic program
you want, why you think you are ready to do it, and how
and where you might want to carry it out. |
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| 4. An application fee of
US$ 1'000.- has to be transferred to: BANCA DEL GOTTARDO,
Lugano (Switzerland), c/c 168142.01.02.00001, Ecoforum for
Peace. |
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| 5. Five passport-size photos
to be used for office use and for identification documents
if you plan to travel outside your home country. |
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