Undergraduate Student Application Form Flexible Learning Centre (FLC) Divine Word University P O Box 483, Madang, Papua New Guinea

Tel: (+675) 422 2937; Fax: (+675) 422 2812; Email: flc@dwu.ac.pg

Province:* Gender:* Male Female Date of Birth:* date selector Status: Married Never Married Separated Widow / Widower Correspondence Address:*

Type format Month/Day/Year.

Office Number: Residence Number: Fax Number: Email Address:* Are you able to use a Computer and Microsoft Word? How will you be sponsored?* Employer Private (Self-Sponsored) Please select the preferred course. I am applying for:* Academic Attainment (Most Recent First) Upload File:* Upload File:* Upload File: Please upload your academic documents Upload File:

Example: 09/16/1975 - 16th September 1975

Upload File: Please list current working location first Employment Record Current Employer:* Position:* Period:* Employer's Address:* Please briefly describe the duties of your current occupation:* Previous Employer:* Position:* Period:* Please briefly describe the duties of your previous occupation:* Previous Employer's Address:*

Scanned copy of non-refundable application fee K100.00

deposited to Divine Word University TDEC A/C No: 1000 433 578*

First Name:* Surname:* Mobile Number:* Upload Receipt: Are you able to use Microsoft Excel? Are you able to use Microsoft PowerPoint? Your english language proficiency level? image image