Incomplete application forms submitted without all supporting documents

will delay the evaluation process. In any documents submitted in support of

your application are found to be fraudulent, the school reserves the right to
reject or withdraw the application /offer made.

APPLICATION FORM
PROGRAMME
UNIVERSITY

INTAKE TERM TERM YEAR REG ID: FOR OFFICIAL USE

1. PERSONAL DETAILS (WRITE IN BLOCK LETTERS)

SURNAME: ……………………………………………………………………………………………………………………………………………………………..

FIRST NAME (S): …………………………………………………………………………………………………………………………………………………….

NAME TO BE PRINTED ON THE CERTIFICATE:

_______________________________________________________________________________________________
____________________________________________________________________________________________

DATE OF BIRTH:

D D M M Y Y Y Y
E -MAIL: …………………………………………………………………

MARITAL STATUS: MARRIED SINGLE GENDER: MALE FEMALE

NATIONALITY: …………………………………………………………………………………………………………………………………………………….

RELIGION: ……………………………………………

ADDRESS IN SRI LANKA: ADDRESS IN HOME COUNTRY: (for International Students)

………………………………………………………………………………… ………………………………………………………………………………….

………………………………………………………………………………… …………………………………………………………………………………..

………………………………………………………………………………… ………………………………………………………………………………….

PHONE IN SRI LANKA PHONE IN HOME COUNTRY

RESIDENTIAL CONTACT NO: …………………………………….. RESIDENTIAL CONTACT NO: ……………………………………………
MOBILE NO: ……………………………………………………………. MOBILE NO: …………………………………………………………………
NIC:
PASSPORT NO:
COUNTRY OF ISSUE: ……………… PLACE OF ISSUE: ………………

ISSUED DATE: ……………………… EXPIRY DATE: ………………….

Auston Institute of Management Ceylon
534, Galle Road, Colombo 03
112576596/0718 734 227
www.auston.edu.lk
 2. CONTACT PERSON
IN CASE OF EMERGENCY

CONTACT PERSON: ……………………………………………. CONTACT NO: ………………………………………….

RELATIONSHIP: ………………………………………………….. OCCUPATION: ………………………………………….

3. EDUCATIONAL BACKGROUND (ACADEMIC & PROFESSIONAL QUALIFICATIONS)

NAME OF THE INSTITUTE COURSE COMPLETED YEAR

4. EMPLOYMENT HISTORY
PERIOD OF WORK
NAME OF COMPANY COUNTRY POSITION HELD
FROM (yyyy) TO (yyyy)

5. FINANCIAL ARRANGEMENTS

Please indicate how you intend to finance your education program with Auston:
Self-Financed Family Member Support Sponsor/Employer

Bank Loan Others (Please specify)

Auston Institute of Management Ceylon

534, Galle Road, Colombo 03
112576596/0718 734 227
www.auston.edu.lk
6. DECLARATION & UNDERTAKING

I am aware/understand/have been told of the following:

 Auston Location and Facilities

 Auston Application, Course Requirements and Criteria;
 The course I am applying for; The award I am applying for(degree/diploma);
 The fees of the course;
 The Payment Policy, Refund Policy, Transfer Policy and Withdrawal Policy;
 The modules in my course, The modules outline;
 The course duration and assessment schedules
 The Promotion criteria;
 Go through the Student Handbook available in the portal (moodle.auston.edu.lk)

I certify that all information given by me in this application form is true and correct. I understand that any
misrepresentation or omission of information may make me ineligible for admission or subject to dismissal. I
understand that if I am unable to provide the documents to support the information provided, Auston Institute of
Management has the right to withdraw the offer without any refund of application or course fees paid. I also
authorize any investigation conducted upon the information provided for the purposes of verification.

I have read and understood all the information in the brochure/prospectus/and items stated above.

I undertake to meet the prerequisite academic requirements to follow the program applied for. Such undertaking
includes but is not limited to, taking additional modules at my own cost, as deemed necessary by Auston Institute of
Management. I also agree to follow the course/assignments deadlines determine by Auston Institute of
Management.

I agree not to hold Auston Institute of Management responsible in any way for my achievements or results in the
programme applied for.

Name & Signature of Date Witnessed by Consultant

the Student

Auston Institute of Management Ceylon

534, Galle Road, Colombo 03
112576596/0718 734 227
www.auston.edu.lk
 7. FEEDBACK

Please help us complete the following questions.

1. Where did you first hear about Auston?

Newspaper Advertisements Exhibitions/Tradeshows Leaflet Distribution

Tuition Class Professional Associations(Please Specify)

Email Campaigns Referred/Introduced by: (Friend’s Name)

Others (Please Specify)

2. Why did you choose Auston?

Duration Recognition Price
Others

3. Name of Program Consultant:

I CONFIRM THAT THIS APPLICATION (PAGE 1,2 & 3) HAS BEEN FILLED BY ME &
ALL INFORMATION PROVIDED IS TRUE & ACCURATE.

SIGNATURE DATE

FOR OFFICAL USE ONLY

EVALUATION

Approved for entry to by

(level) (Singapore or Srilanka, Date , Reference)

Comments (Bridging modules, English or Math proficiency, Work Experience, etc)

Auston Institute of Management Ceylon

534, Galle Road, Colombo 03
112576596/0718 734 227
www.auston.edu.lk
 PAYMENT
PAYMENTDETAILS
DETAILS

1 REGISTRATION FEE

2 COURSE FEE (M/S/F)

3 LIBRARY DEPOSIT (REFUNDABLE)

TOTAL
FOR OFFICE FEE
USE PAID ON REGISTRATION
ONLY: =

Finance Department

Name: _____________ Signature:______________ Date:________________

SPECIAL APPROVALS/COMMENTS

Date: Authorized Signatory:

Payments Accepted & QB Updated: (Finance)

Name: Signature:______________ Date: Time: ____

AIMC SHCML Updated: (SS)

Name: ______________ Signature: Date: Time:

Auston Institute of Management Ceylon

534, Galle Road, Colombo 03
112576596/0718 734 227
www.auston.edu.lk