Short Courses at AKU-ISMC, London
 


Short Courses: A Gateway to Big Ideas

Course Details

*Course Title:
 
(Name of course you are applying for)

Personal Details

*Family Name/Surname: 
*Personal/Given name: 
*Title (Mr/Mrs/Ms etc): 
Date of Birth (mm/dd/yyyy):

*Gender:MaleFemale 

Contact Address

*Address Line 1: 
Address Line 2:
*Town/City: 
*Country: 
Postcode/Zip code:
*Telephone Residence (inc. Country/area code): 
Telephone Work (inc. Country/area code):
Mobile:
*Email:  

*Please specify how you heard about this course:
InternetPosterFlyerColleague
AdvertEducational FairInformationLeaflet
Other: 

Special Requirements
Please state if you have any special requirements during the course ( e.g. disability, dietary requirements or other ):


*Reasons for Applying
Please describe in a maximum of 300 words what features of the course attracted you and how it would benefit you:

 

Previous Education and Experience
*Educational qualifications (including vocational training):
Please include your two most recent qualifications.

Title of Qualification Subject/Course Title Name of Institution Dates of Attendance
From To 

Occupation:

Please state your current status:RetiredHome MakerWorking
Self EmployedOther (please specify):

Work experience:
If you are in employment, please include your two most recent professional experiences.

Name of EmployerAddressJob titleDates of Employment
FromTo

For International Applicants (please complete this additional section)

Nationality:
Current country of residence:

Do you require a Visa to enter UK?YesNo

I understand that if I am not granted visa, my fee will be refunded according to the terms and conditions listed on AKU-ISMC's website. I have read these terms and conditions.

Payment Details (Select as appropriate)

*Proposed Source of finance:SelfEmployerOther 




*Payment:CashChequePostal OrderBank Draft 

Please note that full payment is required before your enrolment can be confirmed.
All cheques and postal orders should be made payable to “The Aga Khan University (International) in the UK”

* Only applications and payment received before the early bird deadline will be eligible for this rate. **Limited concession spaces are available to full-time students, pensioners and those receiving income supports. Please enclose a copy of relevant document(s) if applying for a concessionary rate.

*UK Data Protection Act and Declaration
Please read the following statement carefully before you submit your application. We cannot accept your application without you ticking this box. This document forms the legal basis of your application to AKU-ISMC. We reserve the right to refuse admission in the event of any misrepresentation by you. Submission of an application does not imply an offer of admission.

 I agree to AKU-ISMC entering the information provided on this application form on to their database(s). I agree to the processing of the data for any purpose connected with my studies or my health and safety or for any other legitimate purpose.
  I certify that all the information given in this application form is complete and accurate and understand that if I have given false or misleading information AKU-ISMC may not admit me as a student and may take legal action against me.
 I confirm I have read the Terms and Conditions