Application Form
Application Form
1. Personal Details
Title Mr □ Mrs □ Miss □ Ms □ Other □ Gender Female □ Male □
Name
Last Name(Family Name) First(Surname) Middle(If you have one)
Date of Birth / / in ,
Month Day Year City Country
Country of Citizenship
Mailing Address:
Phone: Fax Mobile
Email:
2. Educational Details
Name of Home University:
Major:_________________________________________
Minor:___________________________________________
3. Application Details
Please indicate your length of stay. Semester 1 □ Semester 2 □ Short-term □
5. SIGNATURE
I declare that to the best of my knowledge the information given in this application is correct and complete in every
particular. I recognize that it is my responsibility to provide all necessary documentary evidence of my
qualifications and studies and hereby authorize PKNU reserves the right to withdraw my offer or enrollment at any
stage during my course where false or misleading information has been provided.