Admission Test Pass (TP) No.

_______________

N orth South U niversity

Plot # 15, Block # B, Bashundhara R/A, Dhaka-1229, Bangladesh, Phone: 885-2000 ext. 1166 & 5000, Fax: 885-2016

APPLICATION FOR ADMISSION - UNDERGRADUATE PROGRAMS

North South University (NSU) is committed to the principles of equal opportunity and is open to all students with required academic qualifications. It does not discriminate between age, race, sex, religion, nationality and social group. Application for admission in 20________ Spring (Jan-Apr) 1. Print your name: First Name Middle Name Last Name Other Name Summer (May-Aug) Fall (Sep-Dec)

National ID# ___________________________________________________________ (if any) Date of Birth : Day Male Month Female Year Place of Birth Married Weight ___________ kg Citizenship Single color of hair ___________________
Please affix two passport size photographs here

Height ___________ meter

Identification mark __________________________________________________________(if any) 2. Fathers Name: ___________________________________ Occupation: _______________________________________ Designation: ______________________________________ Work Address: ____________________________________ _____________________________________ 3. Mailing Address : ____________________________ House# / Holding# ____________________________ District /State ____________________________ Home Phone 4. __________________________ Street / Road __________________________ Postal Code __________________________ Parents Work Phone ____________________________________ Area/ Village/ P.S./ City ____________________________________ Country ____________________________________ Other Mothers Name:______________________________________ Occupation: __________________________________________ Designation: _________________________________________ Work Address:________________________________________ ________________________________________

State in order of Preference the Department or Degree for which you are a candidate. First ____________________ Second ____________________ Non Degree

INSTRUCTION
a. The application processing fee of Tk. 800 (US $20.00 for overseas applicants) is nonrefundable. The forms are available at NSU Accounts Office. You can also download application form from the NSU website: www.northsouth.edu. [payment of Tk 800 must be the made with pay order during submission of application form.] A complete application includes: (i) application form (filled out); (ii) four passport size photographs (attested*); (iii) clean copies of certificates and mark-sheets; (iv) two letters of recommendation/testimonial from previous institutions and (v) photocopy of National ID Card. (You may submit the ID card within one year if not available now). b. The final decision regarding admission is based on the candidate's academic background and performance in the written test. Photographs should be attested by a gazzetted officer orPprincipal/Head of the Department of the last academic institution attended.

Do not write in this area. Degree Non-Degree Accepted conditionally Not accepted

5.

Permanent Address: House# / Holding# District / State Street / Road Postal Code Area / Village / P.S / City Country

6.

Who will pay your tuition and other fees? Self Father/Husband Mother *Other

*Please specify relationship ______________________________________ Name and Address of the Person who will be paying your tuition and fees: [All your academic records will be released to this person unless advised otherwise in writing] Name and Designation: Mailing Address:

Work Phone

Home Phone

Other

7. Do you have a major handicap? If yes, describe briefly or attach a statement.

Yes

No

8. Have you ever been dismissed, suspended or expelled from any institution of learning? If yes, describe briefly or attach a statement.

Yes

No

9. Did you appear at the NSU Admission Test before ? If yes, state TP# and date of admission test.

Yes

No

10. Were you admitted into NSU before? If yes, state ID# and date of admission.

Yes

No

11.

Are you an adibasi?

Yes

No

12. List the schools, colleges and universities you have attended, with dates of attendance. S.S.C./ Secondary School
Institution Board/University From(mm/yy) To(mm/yy) Division/Class/GPA/Marks

H.S.C./High School /GCE

Institution Board/University From(mm/yy) To(mm/yy) Division/Class/GPA/Marks

College / University
Institution Board/University From(mm/yy) To(mm/yy) Division/Class/GPA/Marks

13. Experience (Professional, Business etc.) Account for all of your time since completion of HSC or equivalent examinations.
Institution / Organization Position / Title Dates

14. Merit Scholarships, other Academic Honors and Awards you have received.

15. I hereby accept that if admitted to North South University, I will be bound by the rules and regulations of the

University and the NSU student code of conduct. I understand that manufacture, distribution, possession and consumption of tobacco products, alcohol, drugs, and controlled (illegal) substances at NSU premises are strictly prohibited and that I may be expelled for violating the prohibition or for abetting violations. I am aware that withholding information requested in this application or giving false information will make me ineligible for admission into NSU, and will render me liable for dismissal, if admitted. I hereby certify that the above statements are correct and complete to the best of my knowledge.

Signature of the Person stated in item # 6

Signature of the Applicant

Full Name (print) Note : The application will not be processed unless signed.

Full Name (print)

Admission Test Pass No. Please write your name & address below:

(For official use only)

Name : ________________________________________________________________ Address : ______________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ National ID# ______________________________ Phone : _______________________
Please affix a passport size photograph here

Admission Test Pass (TP#) No. __________________________________ (For official use only) Name: ____________________________________________________________________________ Fathers Name: _____________________________________________________________________ Mothers Name: ____________________________________________________________________ National ID# ____________________________________ Phone: ___________________________ Identification mark: ___________________________________________________, Color of hair: _________________________ Please affix a passport size photograph
here

Do not write below the perforation { Admission Test Pass Instructions (AM)

Please be seated by 8:45 AM. The test starts at 9.00 A.M Mobile Phone, Radio Devices, Electronic Dictionary, and calculators are prohibited. Bring you own pencils, sharpeners, erasers etc.