THE UNIVERSITY OF THE WEST INDIES

School for Graduate Studies and Research

APPLICATION FOR GRADUATE PROGRAMMES

FOR OFFICIAL USE

The accompanying Instruction sheet provides detailed information on the completion of this application form. All applicants are urged to read this
information carefully.
SECTION A – PERSONAL DATA
1. Name
Title Surname/Last Name First Name Middle Name(s)

2. Former Name(if applicable)

(a) Surname/Last Name First Name Middle Name(s) 2(b)
Title Maiden (Prior to) Deed Poll
3. Have you previously applied to the UWI? 5. If answer to question 4 is yes, please state the following:
Yes No (a) Identification Number (b) From (year) (c) To (year) (d) Campus

4. Have you previously been a student at the UWI? (e) Programme

Yes No
6. Gender 7. Date of Birth (dd/mm/yyyy) 8. Tax Number/National I.D.
Female Male _______/_______/______________
9. Marital Status 10. Religion/Denomination
Single Married Common Law
Legally Separated Divorced Widowed
11(a). Do you have a disability? (This information is needed in case special facilities are required) (b) If yes, please specify
Yes No
12. Country of Birth/National of 13. Country of Citizenship 14(a) Country of Residence (b) Duration (years)

15. Country of Responsibility for Fees (see Instruction sheet) 16. Father’s Nationality 17. Mother’s Nationality

18(a) Are you a UWI Staff Member? Yes No 19(a) Are you a dependent of a UWI Staff Member? Yes No
If yes, state: If yes, state the following for the Staff Member:
(b) Staff Identification Number: _____________________________________ (b) Name & Relationship: ___________________________________________

(c) Campus & Department: _________________________________________ (c) Campus & Department:__________________________________________

20. Please list any sporting/community/cultural or social activities in which you have been involved.

21. How did you obtain information about the UWI?

UWI Alumni Direct Mail Employer
Internet Media Other : Please specify _______________________________

SECTION B – APPLICANT CONTACT INFORMATION

22.(a) Permanent Address: Apt/Street/PO Box 23.(a) Mailing Address (If different from 22)
Apt/Street/PO Box

City/Town/Post Office Parish/ County City/Town/Post Office Parish/ County

State Zip Code/Postal Code Country State Zip Code/Postal Code Country

(b) Name of Contact (if any) (b) Name of Contact (if any) (c) Active Dates (if applicable)
From ___/___/____ To __/__/_____

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 Applicant Telephone & Email Emergency Contact Information:
Information 30. Name
24. Home/Permanent Phone Title Surname/Last Name First Name Middle Initial
( ) -
25. Mailing Address Phone 31. Relationship of Contact 35. Permanent Address: Apt/Street/PO Box
( ) -
26. Cell Phone 32. Emergency Contact Home Phone
( ) - ( ) -
27. Work Phone 33. Emergency Contact Cell Phone
( ) - Ext ( ) -
28. Fax Number 34. Emergency Contact Work Phone City/Town/Post Office Parish/ County
( ) - ( ) - Ext
29. E mail Address State Zip Code/Postal Code
Personal:
Business: Country

SECTION C – CHOICE OF CAMPUS & PROGRAMME

36. Expected Date of Entry: 37. Choice of Campus 38. Mode of Delivery (if applicable) 39. Status
________/____________ Cave Hill Mona
mm/year St Augustine Open Campus Online Distance Full Time Part Time
40. Faculty 41. Department/Centre

42. Type of Programme:

EMBA MBA MHRM MSW MD DM MPH
MA MEd MLS MFA LLM MSc MPhil
PhD PG Diploma DBA
43. Name of Programme: 44. Specialization (if applicable).:

To be completed only by applicants to the MPHIL, PHD, DBA & MD programmes.

45. Proposed field of research: (state briefly here and attach a short Research Proposal).

46. Have you done any research in the proposed field of study (if yes please enclose details on a separate sheet of paper). Yes No
47. Details of Publications Give Titles, Names of Journals and Dates. (Give the details on a separate sheet of paper):

SECTION D – ACADEMIC RECORD

48. (a) Non-UWI graduates must arrange to have degree granting Institution(s) send transcripts to the Assistant Registrar, Graduate Studies & Research.
Transcripts not in English must be accompanied by a certified English translation.
Name & Address of Institution Cert/Deg/Dip/ From/To Class of Major/Minor/ Subject Date of Award
Professional Qual. Honours/GPA Area
(i) From: . .
To:

(ii) From:
To:

(iii) From:
To:

(iv) From:
To:

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 48 Continued
(b) Professional experience including teaching experience (give details including dates).

(c) Research experience (if any):

(d) State major accomplishments including prizes, academic or professional distinctions, awards and honours:

49. List Academic programmes or examinations for which you are preparing or awaiting examination results.
COURSE/PROGRAMME NAME & ADDRESS OF INSTITUTION EXPECTED DATE OF AWARD (dd/mm/yyyy)

SECTION E - EMPLOYMENT RECORD

50. Are you currently self employed? Yes No If yes, please state type of Business:
List employment information starting with your current job
(a) Name of Employer (b) Name of Employer

Position Position

Telephone Number Telephone Number

Address: Apt/Street/PO Box Address: Apt/Street/PO Box

City/Town/Post Office Parish/ County City/Town/Post Office Parish/ County

State Zip Code/Postal Code Country State Zip Code/Postal Code Country

From To From To
_____/______/__________ _____/______/____________ _____/______/____________ _____/______/___________
_
(c) Name of Employer (d) Name of Employer

Position Position

Telephone Number Telephone Number

Address: Apt/Street/PO Box Address: Apt/Street/PO Box

City/Town/Post Office Parish/ County City/Town/Post Office Parish/ County

State Zip Code/Postal Code Country State Zip Code/Postal Code Country

From To From To
_____/______/___________ _____/______/____________ _____/______/____________ _____/______/________

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 SECTION F – FINANCIAL RESOURCES
51. Source of Funding
Government (specify):__________________________________ Loan Parents Self
Donor (specify):_______________________________________ Award (specify): ________________________________________

SECTION G – REFEREE INFORMATION

52. Name Two Referees
Names & Addresses of two academic referees (including at least one of your past University lecturers/research supervisors). Applicants with relevant work experience
must nominate a person with knowledge of their employment activity to act as one of their referees. Referees must submit a confidential assessment of the applicant on
the Referee’s Report - Admission form (available on the website of the Campus Office of Graduate Studies and Research).
(a) Name of Referee (b) Name of Referee

Name of Organization Name of Organization

Position Position

Address: Apt/Street/PO Box Address: Apt/Street/PO Box

City/Town/Post Office Parish/ County City/Town/Post Office Parish/ County

State Zip Code/Postal Code Country State Zip Code/Postal Code Country

SECTION H – PROGRAMME SPECIFIC INFORMATION

53. To be completed only by applicants to the Human Resource Development and Schools of Business Programmes.
(a) Job Title of immediate Supervisor:
(b) No. of persons reporting to you directly: (c) Indirectly:

(d) State how this area of study fits into your career plans:

(e) How will this programme enhance the development of your organization?

(f) What do you consider your strengths and limitations in relation to your desire to pursue the degree indicated?

(g) SUBJECT MATTER COMPETENCE (Please indicate the highest level to which you studied each subject and the grade obtained).
Subject Highest Level Studied: Most Recent grade Assessment of competence: (No exposure,
“O” or “A” Level; Minor/ obtained Fair, Adequate, Good, Proficient)
Major at Tertiary Level
Accounting
Economics
Mathematics
Statistics
Computer Applications
Foreign Language(s) specify

(h) Describe clearly and concisely, your reasons for applying for admission to the programme selected, the contribution which you expect it to make to your personal and
professional development, and the contribution you anticipate making to the learning process.

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(i) Describe clearly and concisely, your major strengths in undertaking graduate studies, the factors which could impede your performance and the steps which
you intend to take to offset the impact of such factors.

54. To be completed only by applicants to the PG Diploma in Education.

(a) Present Post (e.g. Teacher II, Vice-Principal, Principal):
(b) Present School Name & Address: (c) Select the subject you wish to be trained to teach:

(d) How many periods per week of the subject named above do you presently teach:
(e) How many periods per week of this subject are you likely to teach during the course:
(f) Teaching record and subjects taught, including present post:
Date School Subject(s) Taught

SECTION I - DECLARATIONS

DECLARATION OF THE CEO OF ORGANISATION

55. To be completed by applicants to the Schools of Business, and Mona HRD and MIS programmes
This application is being made with my full knowledge and approval. I undertake to give this employee sufficient time off from work to permit effective
participation in this programme
Name of CEO Title
Signature Name of Organisation

DECLARATION OF APPLICANT
56. I certify that the facts stated are correct and I declare that I am willing to study for such period under such general supervision as the Senate may appoint, and
that I am not registered and have not applied to register as an Internal or External Student of any other University or for any other degree in this University.

_______________________________ ______/______/___________
Signature of Applicant Date (dd/mm/yyyy)

DOCUMENT CHECKLIST

Your application will not be processed until all supporting documents are received:

All Applicants
Application form fully completed in duplicate (applicable only to candidates submitting paper applications)
Receipt of payment of Non-Refundable Application Fee (applicable only to candidates submitting paper applications)
Marriage Certificate (where applicable)
Legal Affidavit or Deed Poll if present name is different from that on the Birth Certificate
Professional Certificates/Diplomas obtained from other Institutions
Two (2) referee reports
Research Proposal (M.Phil., Ph.D. DBA and M.D. applicants only)
Curriculum Vitae (Schools of Business applicants only)
Confirmation of Employment (applicants only to Engineering programmes)

Additional documents for Non-UWI Graduates

Birth Certificate
Transcripts of previous degrees
TOEFL Score of 500 or greater (if English is not your first Language)

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 FOR OFFICIAL USE ONLY:

Information to be supplied by the Head of Department/Centre to which entry is being sought.

A. Is the applicant acceptable for entry? Yes No

B. Should the applicant be required to sit:
i) Qualifying Examinations? Yes No ii) Departmental Examinations? Yes No
If yes, give details below
COURSES FOR EXAMINATIONS
QUALIFYING DEPARTMENTAL
Course Course Title Course Course Title
Code Code

For MPhil, PhD, DBA and MD applicants only:

C. Proposed Supervisor: Proposed Co-Supervisor:
Name: ________________________________________________ Name: ______________________________________________________
Position ______________________________________________ Position: _____________________________________________________
Area of Specialisation: ___________________________________ Area of Specialisation: _________________________________________

D. Proposed Committee of Advisors:

Name: ________________________________________________ Name: ______________________________________________________
Position: ______________________________________________ Position: ____________________________________________________
Area of Specialisation: ___________________________________ Area of Specialisation: _________________________________________

Name:_________________________________________________
Position:_______________________________________________
Area of Specialisation:____________________________________

E Do adequate facilities/materials for research work exist? Yes No

F If the answer is No, please state reason/s briefly:

_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________

Signature:___________________________________________________ Date:__________________________________
Programme Coordinator

Signature:___________________________________________________ Date:__________________________________
Proposed Supervisor (for MPhil, PhD, DBA and MD applicants)

Signature:___________________________________________________ Date:__________________________________
Head of Department/Centre

Signature:___________________________________________________ Date:__________________________________
Chairman, Campus Committee for Graduate Studies & Research

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