SCHOLARSHIP APPLICATION FORM

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Building 39A+B, Street 592, Sangkat Boeung Kak 2, Khan Toul Kork, Phnom Penh, Cambodia. Tel: 070 592 888 / 017 592 888 I www.ute.ac I info@ute.ac

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PERSONAL DATA

FULL NAME IN ENGLISH
GENDER
MARITAL STATUS
ADDRESS

PROPOSED PROGRAM OF STUDY

1-DEGREE APPLIED FOR:
2-PREFERRED TIME OF STUDY:
3-FIELD OF STUDY APPLIED FOR

EDUCATION RECORD

ENGLISH LANGUAGE PROFICIENCY

Please specify your English language proficiency
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EMERGENCY CONTACT

PARENTS/GUARDIAN INFORMATION (Please provide both father and mother or guardian information)

HOW DO YOU KNOW ABOUT UTE?

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DECLARATION BY STUDENT

I declare that all the information provided in the application is true according to my knowledge. I am aware that if I deliberately convey wrong information or mislead the university, I will be kept accountable under the law for my actions.

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SIGNATURE OF APPLICANT

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