IAR Form | Academic Temple

SECTION ONE – PERSONAL DETAILS

Title *

Mr
Mrs
Miss

Others

Name *

First

Last

Other Names

Date of Birth *

Birth Certificate

Click or drag a file to this area to upload.

Please upload a copy of your birth certificate

Gender *

Male
Female

Country of Citizenship *

Ethnicity *

SECTION TWO – CONTACT DETAILS

Current Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Home Phone *

Mobile Phone *

Email *

Emergency Contact

Name *

First

Last

Relationship to You?

Phone

SECTION THREE – PROGRAMME SELECTION

Programme 1

Programme 2

SECTION FOUR – ENGLISH PROFICIENCY

What is your first language?

Have you ever had your English abilities or proficiency tested?

Yes
No

Date of Assessment

SECTION FIVE – SECONDARY SCHOOL STUDIES

please provide verified official documentation of academic results for all qualifications

Name of School

Highest Qualification

Year Started

Year Finished

Successfully Completed

Yes
No

Upload Results

Click or drag a file to this area to upload.

SECTION SIX – TERTIARY SCHOOL STUDIES

please provide verified official documentation of academic results for all qualifications

Name of School

Highest Qualification

Year Started

Year Finished

Successfully Completed

Yes
No

Upload Results

Click or drag a file to this area to upload.

What is the highest tertiary qualification you hold?

Other Qualifications

Please upload a verified translation of your results.

Click or drag a file to this area to upload.

SECTION SEVEN – STATISTICAL INFORMATION

How did you hear about Academic Temple Educational Consult? please tick one.

Others

SECTION EIGHT – IMPAIRMENTS

Do you live with the effects of a significant injury, long-term illness, or disability?

Yes
No

If yes, please indicate by ticking the appropriate box below

Others Please specify

SECTION NINE – IMPORTANT DOCUMENTS

Please upload the following documents.

Passport Photograph

Click or drag a file to this area to upload.

International Passport

Click or drag a file to this area to upload.

Account Statements (6 months – 1year)

Click or drag a file to this area to upload.

SECTION TEN – FAMILY INFORMATION

Father’s Information

Deceased
Unknown

Family Name(s)

Given Name(s) First:

Given Name(s) Middle

If Address is Same As Applicant

Yes
No

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Email

Employer

Occupation

Mother’s Information

Deceased
Unknown

Family Name(s)

Given Name(s) First:

Given Name(s) Middle

If Address is Same As Applicant

Yes
No

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Email

Employer

Occupation

Enter your email Address

SECTION ONE – PERSONAL DETAILS

SECTION TWO – CONTACT DETAILS

Emergency Contact

SECTION THREE – PROGRAMME SELECTION

SECTION FOUR – ENGLISH PROFICIENCY

SECTION FIVE – SECONDARY SCHOOL STUDIES

SECTION SIX – TERTIARY SCHOOL STUDIES

SECTION SEVEN – STATISTICAL INFORMATION

SECTION EIGHT – IMPAIRMENTS

SECTION NINE – IMPORTANT DOCUMENTS

SECTION TEN – FAMILY INFORMATION

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