10/22/2009 PG1

University of Malawi

Chancellor College

P.O. Box 280, Zomba, MalawiTel: (265) 524222; Fax (265) 524046; E-mail: Admin@chirunga.sdnp.org.mw

APPLICATION FOR REGISTRATION AS A POSTGRADUATE STUDENTTo be presented in triplicate and to be sent to the respective Department

A. PERSONAL1.Surname: ………………………………… 2. Forenames: ……………………………….

3.Sex: ……………………………………… 4. Date of birth: ……………………………..

5.Nationality: ………………………………. 6. Country of birth: ………………………….

7.Marital status: ……………………………. 8. Maiden name: …………………………….

(if married woman)9. Home address: ……………………………………………………………………………………..

……………………………………………………………………………………………………..10. Present postal address: …………………………………………………………………………….11. E-mail address:…………………………………………………………………………………….12. Next of kin: (a) Name ………………………………………………………………………..

(b) Address: …………………………………………………………………….

………………………………………………………………………………….

(c) Relationship …………………………………………………………………

B. TERTIARY EDUCATION13. First Degree: ………………………………13.Awarding Institution: …………………….

14.Date of award: …………………………….15.Class of award: …………………………...16. Other degrees or awards (give name of awarding institution/body and date):

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(attach copies of transcripts and certificates of tertiary education qualifications)

17.Research experience: …………………………………………………………………………….

……………………………………………………………………………………………………..

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C. DETAILS OF PROPOSED STUDY

18. Degree Sought: …………………………………………………………………………………..19. Proposed area/discipline of study (i.e. Biochemistry, Ethnobotany) ………………………20. Proposed topic of study: ………………………………………………………………………..21. Method of study (e.g. part-time or full-time) …………………………………………………

0/22/2009 PG1

D. REFEREES (candidate to solicit the references)22. Name and addresses of TWO Academic Referees:

(a) Name:…………………………………………………………………………………………….

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(b) Name:…………………………………………………………………………………………….

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Signature of Applicant ……………………………Date:……………………………….

E. FOR COLLEGE USE ONLY

23.Application presented by: Name: ………………………………………………………

Position:…………………………………………………….

24.Application considered by Post-graduate Committee on: ..………………………………...

25.Recommendation of Post-graduate Committee:……………………………………………..

……………………………………………………………………………………………………..

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Signature of Chair of Post-graduate Committee:…………………………………………….