Application Form
CHRIST’S UNIVERSITY IN PACIFIC
APPLICATION FOR ADMISSION
P.O Box 367, Nuku’alofa, TONGA (South Pacific)
New Student Admissions Information
Email: info@cup.edu.to
Office Phone: (+676) 28-125
Please print in pen or type all information
Legal name: Mr/Mrs/Miss ______________________ /___________________ /_________________
Last (family name) First name Middle name
Male Female
Usually called: ______________________ Birth date: ________/________/________
Day Month Year
Mailing Address: _________________________ /________________________ /___________________
P.O Box (street) City Country
Telephone No: _______________________ E-mail address ___________________
Place of birth: ______________________
Citizenship: Tonga New Zealand Australia USA Other: ___________
Non-Tongan citizen: Are you a permanent resident? Yes No If yes, give Admissions
No:______________
Current marital status: (Circle all that apply) Married
Spouse’s full name: __________________
Never married Widow or Widower Separated
Divorced Remarried Single Parent
ADMISSION INFORMATION
Applying to attend: University
What level you’re entering? ___________ (Level 4, 5, 6, 7, 8, 9, 10)
Entrance date: Semester I ________________ Semester II _______________________
Year Year
Probable major: ____________________ (See list of Academic Degrees available and tick one box)
Certificates (L-4) Diploma (L- 5) Advanced Diploma (L-6) Bachelor (L-7)
Postgrad Cert. (L-8) Postgrad Dip. (L-8) Master (L-9) Doctoral (L-10)
EDUCATION
Please list all Colleges, High Schools, institutes or technical school you have ever attended. If you have attended more than two schools, submit additional information on a separate sheet.
Name of School: ____________________________ Dates attended: __________________
Degree received: _________________________
Mailing address: ______________________________________________________________________________
P.O Box (or street) City Country
Name of School: ____________________________ Dates attended: __________________
Degree received: ____________________________
Mailing address: _______________________________________________________________________________
P.O Box (or street) City Country
Do you expect to transfer credits from another university or institution? Yes No (If yes, you must have another official copy of your transcript on file at Christ’s University in Pacific before these credits can be evaluated by the Records Office for possible transfer. It is the applicant’s responsibility to request the forwarding institution to send an official transcript to Christ’s University in Pacific. Request forms are available in the Registrar’s Office).
FAMILY
Father’s name: _____________________________________ Occupation: ___________________
(Indicate ‘Deceased’ if not living)
Permanent address: ___________________________________________________________________________________
P.O Box (street) City Country
Mother’s name: _____________________________________ Occupation: ___________________
(indicate ‘ Deceased’ if not living)
Permanent address: ___________________________________________________________________________________
P.O Box (street) City Country
Has any member of your family ever applied for admission or attended Christ’s University in Pacific?
Yes No
If Yes, give the names and relationship.
________________________________________________________________________________
________________________________________________________________________________
CONFIDENTIAL
Have you trusted (or accepted) Jesus Christ as your personal Saviour? Yes No
When? ________________________________
Do you read the Bible daily? Yes No Sometimes
Do you pray daily? Yes No Sometimes
Are you a church member? Yes No Sometimes
Do you attend regularly? Yes No Sometimes
Denomination: _____________________ Pastor’s name: ________________________
Name of church: ____________________ Telephone no: _________________________
Check appropriate box:
Yes No Do you have or have you ever had any significant physical learning impairment
Yes No Have you ever been treated for any nervous, mental, or emotional disorder, or seen a Psychologist?
Yes No Have you ever used illegal or dangerous drugs?
Yes No Have you in any way used alcoholics’ beverages?
Yes No Have you used tobacco in any form?
Yes No Were you ever expelled, dropped, or suspended by any school or university?
Yes No Are you or have you ever been under the supervision of a parole officer?
Yes No Have you ever been arrested for any reason other than a minor traffic violation?
If any answer is affirmative, please give complete and accurate. I also understand that I am financially responsible for the payment of this account if the student listed on the front of this application is accepted for enrolment.
I certify that the information given on this application is complete and accurate. I also understand that I am financially responsible for the payment of this account if the student listed on the front this of this application is accepted for enrolment.
Applicant’s signature: _______________________ Date: _________________
Signature of parent, guardian, or sponsor: ____________________________
BE SURE TO ENCLOSE YOUR T$100 APPLICATION FEE