Agora School of Business Application

Section I: General Information

First Name *

Last Name *

Birthdate *

Home Phone

Mobile *

Email Address *

Nationality *

Address *

Primary Address City *

Primary Address State *

Primary Address Country *

Residents details

Country of Permanent Residence *

Country of Birth *

Employment Information

Current Employer *

Job Title *

Gross Monthly Income *

Job Start Date *

Copy of last three pay slips or HR Letter *

How would you finance the non-scholarship element of your program fees? *

Please detail below how you intend to fund the balance of the program fees *

Do you have children/adults who rely on your income for support? *

Reference

Please provide reference as to character, conduct and eligibility for this scholarship. Cannot be a family member. Please attach letter to this application.

Referee's Name *

Referee's Occupation *

Referee's Phone Number *

Referee's Email Address *

Declaration

I hereby declare that the information contained in this form of application are correct and I confirm that i will notify Agora School of Business of any changes.

I also understand that the scholarship award decision is at the sole discretion of Agora School of Business and that there is no right of appeal.

I confirm that I would be happy to be contacted by Agora School of Business for an interview if required.

By signing your name electronically on this form, You are agreeing that your electronic signature is the legal equivalent of your manual signature on this form. *

Signature *

Date *