GENERAL APPLICATION (PART A) All relevant fields must be completed before this application will be considered. This form is required for application to all programs of study in addition to any supplementary forms.
SECTION 1: PERSONAL INFORMATION Fanama
Eyinimidenbofa
Justin
UBC Student Number
Last Name
First Name
Middle Name
1984/05/19
Former Last Name
Male Female Sex (Select One) ✔
Birth Date
Social Insurance Number
SECTION 2: CONTACT DETAILS Bukit Jalil Arena Green
Block-A-3A-10
Street Address Line 1
Street Address Line 2
Kuala Lumpor
Kuala Lumpor
Malaysia
57000
City
Province/State
Country
Postal/Zip Code
+60172448376 Phone Number
Kuala Lumpor
jdfansss@yahoo.co.uk
Fax Number
Email Address
SECTION 3: CITIZENSHIP Nigeria
English Language
Country of Birth
First Language
Other Language
Citizenship Status (Select One) Canadian
Permanent Resident
Student Authorization
✔
Unknown
Malaysia
Country of Residence
Entry Date into Canada
SECTION 4: ENGLISH LANGUAGE REQUIREMENT Choose the option that best applies to you: English is the primary language of instruction at my post-secondary institution OR the post-secondary institution is located in Canada. (proceed to Section 5) The primary language of instruction at my post-secondary instution is not English AND the post-secondary institution is located outside of Canada.
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SECTION 5: ACADEMIC RECORD Please provide a complete record of your academic history, including the status of your degree or diploma, starting with your most recent instituion. Failure to disclose a complete post-secondary record WILL result in disciplinary action if you are admitted to the program.
Institution Attended
Country
Start Date
End Date
Degree or Degree/Diploma Diploma Type Conferred?
Asia Pacific University College
Malaysia
2006/09
2010/02
Degree
YYYY/MM
of Technology and Innovation
Yes
No
YYYY/MM
Yes
No
YYYY/MM
YYYY/MM
Yes
No
YYYY/MM
YYYY/MM
Yes
No
YYYY/MM
YYYY/MM
Yes
No
If you have attended more than 5 institutions, or require space to clarify any of the above information, please use the comment field below:
SECTION 6: DEGREE AND PROGRAM SELECTION Select your degree and program from the drop-down boxes below. Degree
Program Selection
INTERDISCIPLINARY GRADUATE STUDIES (IGS) ONLY:
Please select either the individualized or themed program. For information on the difference between the two options, please consult the College of Graduate Studies website, or select the help button below. ✔
Individualized Program Option:
Political Science
Themed Program Option: Does your intended field of research include a component of Indigenous Studies?
✔ Yes
No
Students studying in a field which includes Indigenous Studies may chose to enroll in the Summer Institute in Indigenous Studies. If you intend to participate in the Summer Institute, select May as your start date. Page 2 of 3
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SECTION 7: START DATE Select your intended start date. September
January
✔
May
I plan to attend the Summer Institute in Indigenous Studies:
Start dates are subject to program availability. ✔
Yes
No
SECTION 8: DECLARATION AND SIGNATURE THIS SECTION IS MANDATORY: Please review the declaration carefully before signing. I declare that the statements made in this application are, to the best of my knowledge, true, complete and correct. I hereby accept and agree to abide by the regulations and ordinances of the University of British Columbia - Okanagan and the College of Graduate Studies and to any amendments thereto which may be made while I am a student at the University. I hereby authorize the University to contact any education institutions, testing agency or referee relevant to this application in order to verify the authenticity of supporting documents. I understand that the information provided to support this application becomes part of my academic file, and may be used to determine winners of scholarships, fellowships, awards and honours and in subsequent discussions where entrance-level qualifications may be an issue. I understand that the Dean of Graduate Studies reserves the right to revoke an offer of admission resulting, where necessary, in the need for the student to withdraw from his/her degree program if any of the information in this application is found to be untrue or if evidence of fraudulent submission of documentation is found. I understand that I am responsible for ensuring all supporting documentation for my application is forwarded to UBC - Okanagan Graduate Studies by the published deadline. UBC-Okanagan and The College of Graduate Studies are not responsible for errors in electronic transmission or mislaid electronic documents. By typing my name below, I agree to the statements made in this declaration, and acknowledge my typewritten name serves as a signature.
✔
I have read and agree with the declaration
25/08/2009
Fanama Eyinimidenbofa Type Full Name
Date
SECTION 9: OPTIONAL INFORMATION Students who identify themselves as Aboriginal persons will be evaluated in the same manner as every other applicant to UBC. If the University finds that an Aboriginal student is not eligible for admission through the general admissions policies, we will consider the student's application under the Aboriginal Admissions Policy. An Aboriginal person is identified in accordance to the Constitution Act of 1982, Part II, Section 35(2), as "an Indian (including Status, non-Status, Treaty and non-Treaty), Metis or Inuit person of Canada."
Do you identify yourself as an Aboriginal person, that is, First Nations, Metis or Inuit?
Yes
If you identify as an Aboriginal person, are you:
Metis
First Nations
✔
No Inuit
SECTION 10: SUBMIT THE APPLICATION BEFORE YOU SUBMIT YOUR APPLICATION, PLEASE PRINT A COPY FOR YOUR RECORDS.
SAVE
SUBMIT
INSTRUCTIONS This application can be submitted online through your email. Desktop Email Client: If you use a desktop email client, such as Microsoft Outlook or Mozilla Thunderbird, pressing the submit button will automatically attach the completed form in PDF format to a mail message. At this point, you can include additional attachments by adding them to the message prior to sending. You may also change the text in the email body. Internet Email Client: If you use an internet email client, such as Hotmail , Yahoo or Gmail, you will be prompted to save a copy of the completed form to your computer. You should open your email client and attach the file to a new mail message, to be sent to gradadmissions.ok@ubc.ca. Other: If you are having troubles submitting this form, please print a copy and fax it to our office at 250-807-8799. Please contact gradadmissions.ok@ubc.ca with any questions or problems you may have. You may also save a copy of the completed form to your computer for your records by selecting the save button above. These instructions will not print on your final completed form.
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