UNDERGRADUATE ADMISSION 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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PROGRAM SELECTION

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

PERSONAL DATA

FULL NAME IN ENGLISH
GENDER
MARITAL STATUS
CURRENT ADDRESS

EDUCATION RECORD

ENGLISH LANGUAGE PROFICIENCY

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

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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 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.

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SIGNATURE OF APPLICANT

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