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: New Generation Academy Application
Office of Admissions 鶹ý 205 Abdymomunov Bishkek 720040 Kyrgyzstan
Phone: 996 (312) 66-10-89 Fax: 996 (312) 66-10-89 E-mail: admissions@mail.auca.kg www.auca.kg
Registration # ________________
Section 1: APPLICANT INFORMATION
NAME AND RESIDENCE INFORMATION (Please write your name as it appears in official documents both in English and Russian):
Full Name in English (same as passport): ___________________________________________________________________________________ Family Name (Surname) Given Name (First) Middle Name (if any)
Full Name in Russian ( $. . . ) : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ $0<8;8O <O BG5AB2>
R e s i d e n c e I n f o r m a t i o n ( r e q u i r e d ) : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Nationality Country of Citizenship
Date of Birth (day/ month/ year): _______________________________________ Gender : FORMCHECKBOX Female FORMCHECKBOX Male
(i.e. 27 March, 1985)
CONTACT INFORMATION:
Permanent Mailing Address: __________________________________________________________________________________________
House or Apartment Number and Street
____________________________________________________________________________________________________________________
City and District Province /State Country Postal Code
Permanent Phone Number: _______________________________________ Fax Number: ___________________________________________ (country and city code)
E-mail address: ___________________________________________ Mobile Phone Number: ______________________________________
(country and city code)
Current/Local Address: __________________________________________________________________________________________
(If different from above) House or Apartment Number and Street
_________________________________________________________________________________________________
City and District Province/State Country Postal Code
Current Phone Number: _______________________________________ Fax Number: _____________________________________________ (country and city code) (country and city code)
ALTERNATE CONTACT: (This should be someone other than you or your parents, such as a relative, friend, or neighbor)
Full Name: ______________________________________________________________ His/Her relation to you: _______________________
Phone Number: ____________________________________________ E-mail address: _____________________________________________
PASSPORT INFORMATION:
Passport # : ____________________________________________ Passport Country: _____________________________________________
Passport Issue Date (Day/ Month/ Year): ______________________ Passport Expiry Date (Day/ Month/ Year): _________________________
[Please note that all international students must make sure to register and extend their student visas within Kyrgyzstan in a timely manner.]
SECTION 2: Enrollment and ACADEMIC INFORMATION
NGA PROGRAM ENROLLMENT INFORMATION:
Mark the box of the program for which you are applying
FULL-TIME (DAY) PROGRAM - FORMCHECKBOX Fall Semester August 2013 Start-date; FORMCHECKBOX Spring Semester - January 2014 Start-date
HIGH SCHOOL/ SECONDARY EDUCATION:
High School Name and Address: ________________________________________________________________________________________
Name Street Address
____________________________________________________________________________________________________________________
City and District Province /Oblast/State Country Postal Code
Year of Graduation (or anticipated Date of Graduation): ____________________ Certificate/Diploma Number: __________________________
Language of study in High School: FORMCHECKBOX KGZ, FORMCHECKBOX RUS, FORMCHECKBOX TURKM, FORMCHECKBOX TAJ, FORMCHECKBOX KAZ, FORMCHECKBOX UZB, FORMCHECKBOX OTHER _______________
SECTION 3: ENTRANCE EXAM & Interview
鶹ý NGA Program applicants must take the 鶹ý NGA Program Entrance Exam, which is an English language test. Exams are offered in Bishkek, Kyrgyzstan and in select international locations.
All 鶹ý NGA Program applicants must also interview with the NGA Program directly, either in person or by arranged telephone/SKYPE interview.
Note: Those with an English language test score equivalent to 420 on the TOEFL PBT/ 鶹ý TOELP are exempted from taking the NGA Programs Entrance Exam and must only sit for an interview.
DEADLINES AND EXAM SCHEDULE FOR STUDIES BEGINNING IN AUGUST 2013
Application Deadline: June 16, 2013
SECTION 4: FINANCIAL INFORMATION
Please indicate how you intend to pay for your tuition and living expenses in Kyrgyzstan:
In order to process visa support for international students (including students from the CIS), 鶹ý must collect financial information. This information is needed to show the Kyrgyz Ministry of Foreign Affairs that, as an international student, you will have the means to pay for your education and stay while in the Kyrgyz Republic.
Financial information will not be used in any way as a condition of admissions to 鶹ý; it is simply an overview of current resources and potential need. The information you provide is non-binding.Sources of FundsName Source of Funding/ SCHOLARSHIPAssured Support
(In US Dollars)1. Personal/ Family Funds$2. International Organization$3. Government Scholarship$4. Other Source/ Sponsor$Will you require 鶹ý to arrange housing? FORMCHECKBOX Yes FORMCHECKBOX No , if Yes, FORMCHECKBOX Dormitory or FORMCHECKBOX Apartment
SECTION 5: FAMILY INFORMATION
Fathers Name: ______________________________________________________________________________________________________
Home Phone Number: _____________________________________ Work Phone Number: __________________________________________
E-mail Contact (if any): ________________________________________________________________________________________________
Place of Employment & Position Held: ____________________________________________________________________________________
Mothers Name: ______________________________________________________________________________________________________
Home Phone Number: _____________________________________ Work Phone Number: __________________________________________
E-mail Contact (if any): ________________________________________________________________________________________________
Place of Employment & Position Held: ____________________________________________________________________________________
SECTION 6: CERTIFICATION AND ATTESTATION
I certify that all the information provided in this application is complete and true. I understand that any misrepresentation or omission of information may be cause for denial of admission to the 鶹ý NGA Program. I understand that the 鶹ý reserves the right to deny admissions to anyone whom it considers not qualified, and that 鶹ý reserves the right to require withdrawal of any student at any time for any reason it considers sufficient, including due to academic standing and personal conduct. Furthermore, I certify that I understand the admission rules of the 鶹ý NGA Program.
Admission to the 鶹ý NGA Program is dependent upon the results of the admission exams, departments recommendation for admission, submission of originals of documents certifying education, and payment of half of the tuition fee.
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Signature of applicant: ___________________________________________________ Date: _________________________
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FOR OFFICE OF ADMISSIONS USE ONLY: 500 SOMS PAID FORMCHECKBOX Yes or FORMCHECKBOX No
AMERICAN UNIVERSITY OF CENTRAL ASIA
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鶹ý NGA Application 2013-14
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