STUDENT ADMISSION FORM – UTE UNIVERSITY

Please enable JavaScript in your browser to complete this form.

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

APPLICATION TYPE

Please complete this form accurately. You may select one or more of the following application types:

PROGRAM SELECTION

1. PREFERRED STUDY MODE :

Morning
Afternoon
Evening
Weekend

2. FIELD OF STUDY APPLIED FOR :

PERSONAL DATA

Please complete all sections using BLOCK LETTERS.

FULL NAME IN ENGLISH (as in NID/Passport)

First

Last

GENDER

Male
Female

DATE OF BIRTH

FULL NAME IN KHMER (as in NID/Passport)

NATIONALITY

PLACE OF BIRTH

CONTACT NUMBER

MARITAL STATUS

Single
Married

EMAIL ADDRESS

CURRENT ADDRESS

Address Line 1

Address Line 2

City

State / Province / Region

Country

ACADEMIC BACKGROUND

NAME OF FORMER HIGH SCHOOL

START YEAR

END YEAR

PROVINCE/CITY

BAC II. EXAM LOCATION

EXAM GRADE

CERTIFICATE Nº

NAME BAC Layout

ENGLISH LANGUAGE PROFICIENCY

Please specify your English language proficiency.

SELECT

Cambridge

YOUR SCORE:

TEST DATE

SELECT

IELTS

YOUR SCORE:

TEST DATE

SELECT

TOEFL

YOUR SCORE

TEST DATE

SELECT

Not Available

(Students need to complete the UTE/Cambridge English Placement Test. The fee for the placement test will be refunded once they decide to study with UTE. Contact UTE for the UTE/CEPT exam date. For more about the CEPT exam, check here)

EMERGENCY CONTACT

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

FULL NAME

RELATIONSHIP

NATIONALITY

CONTACT NUMBER

CONTACT ADDRESS

DECLARATION BY STUDENT

I hereby understand and agree that it is my responsibility to be aware and abide by all relevant and applicable rules and regulations of the University. I hereby declare that all information herein provided is complete, accurate, and true to the best of my knowledge. I also agree that the University reserves the right to vary or reserve any decision in respect of my registration in the event that the said information is found to be untrue, incorrect, or incomplete. I also agree that in the event the University shall forfeit the said fees, I shall not have any claim whatsoever against the University. I also agree that the University reserves the right to alter, amend, change, or modify the current published fees and all fees payable shall be the published fees at the time of payment.

NAME OF SIGNATURE

_____________________________________

SIGNATURE OF APPLICANT

DATE OF SIGNATURE

APPLICATION TYPE

Please complete this form accurately. You may select one or more of the following application types:

PROGRAM SELECTION

PERSONAL DATA

Please complete all sections using BLOCK LETTERS.

ACADEMIC BACKGROUND

ENGLISH LANGUAGE PROFICIENCY

EMERGENCY CONTACT

HOW DO YOU KNOW ABOUT UTE?

DECLARATION BY STUDENT