This application form and the supporting documents become the property of UCU.
Please fill out this form in MSWord (use cursor to move from field to field) or write legibly in printed letters.
Do not use staples to attach anything to this form.
Year of entry
Full Year (September – May) □ Spring Semester (January – June) □
Fall Semester (September – December) □
^1. PERSONAL INFORMATION
Please attach a recent photo
^1.2. First and middle names
1.3. Date of birth (dd/mm/yy)
1.4. Place of birth
Male □ Female □
^1.6. Family Status
Single □ Married □
1.8. Place of residence
^2. CONTACT INFORMATION
2.1. Permanent Home Address This address will be used for all written documentation
2.6. Telephone (including code)
2.7. Fax (including code)
2.8. Emergency contacts
Father / Mother / Guardian /Other
Father / Mother / Guardian / Other
3.1. Passport number
3.2. Issue date
3.3. Expiry date
3.4. Country of issue
3.5. City of issue
^4. PRESENT ACADEMIC STUDY
4.1 Are you presently enrolled in study? Yes □ No □
4.2. Degree / Qualification
4.3. Undergraduate □ or postgraduate □
4.4. Entry year
^4.5. Graduation year
4.6. University / College
4.8. Address of university
4.14. E-mail (university)
^5. ACADEMIC QUALIFICATIONS HELD
Field of study
University, city, faculty
^6. LANGUAGE PROFICIENCY
Level of proficiency
^7. SUPPORTING MATERIALS
Please provide the following documents together with your application form:
Academic transcript documenting your academic work
If any of the above are not sent with your application form it may delay your application.
It is your responsibility to ensure that this application form and all the supporting materials are submitted by the appropriate deadline:
May 31 for September entry, or
December 10 for entry in February of the following year.
^8. DECLARATION AND SIGNATURE
I confirm that the information provided in this application form is true, complete and accurate and no information requested has been omitted.
I understand the costs involved in attending the Ukrainian Catholic University and accept that it is my responsibility to meet these costs. I understand that failure to settle all debts will result in my transcript being withheld and not released until any such debts are paid in full.
Date ...................................................... Signature of applicant ........................................................
Please fax or email this form and the supporting documents. The originals must be sent by post.