Down in My Personal Galaxy Rabbit Bunny

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F-BTGTI-AF-1.0

BARS TO GO TRAINING INSTITUTE

APPLICATION FORM

Application FormRevised February 2010

1

INSTRUCTIONS: Kindly complete all sections of this form

Two (2) passport size photographs should accompany this form

Attach all supporting documents (e.g. CXC/GCE passes etc)

A non refundable application fee of $1,000.00 should also accompany the

application.

Submit with application your BTGTIET (Bars To Go Training Institute Entrance Test)

Scores of 50% or higher in English (entrance test is required for all applicant)

PLEASE NOTE:

Study option may be withdrawn in the event of under-enrolment in a given

programme.

Section A[ Personal Data]

1 Miss [ ], Mrs. [ ], Ms.[ ], Mr[ ].

_______________ __________________ ___________________ ____________________

(Surname Name) (Christian Name) (Middle Name) (Maiden Name (if applicable)2 Date of Birth:

____/_____/____

dd mm yyyy

3 Gender:Male [ ]

Female [ ]

4 Marital Status:

Single [ ]

Married [ ]

Divorced [ ]

Widowed [ ]

5 TRN #:

_____-_____-_____

6 Nationality:___________________

7 Email Address:

_________________________________

____________

8 Do you have any physical disabilities? YES [ ] NO [ ] ; If yes, please state:

___________________________________________________________

___________________________________________________________

9 Contact

Information:

a

.

Home No.(___) ______ -

_____

b

.

Work No.(___) ______ - _______

c Mobile No.(___)____ -______

Affix

Passport

Size

Photo

Here


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10 Mailing Address: Apt/Street/P.O. Box

_____________________________________________________________

___________________________________________________

___________________________________________________

11 Permanent Address: Apt/Street/P.O. Box

_____________________________________________________________

___________________________________________________

___________________________________________________

12 Employment History

Occupation/Job

Title:

_________________

__

_________________

__

_________________

__

Employer:

________________

_

________________

_

________________

_

Start/End Dates:

___/___To___/___

___/___To___/___

___/___To___/___

Telephone: f. Fax No:

(___) _____ - ______

(___) _____ - ______

(___) _____ - ______

13 Next of Kin

Name: ______________________________________Phone Number: _______________________________

Relationship: _________________________________

Address: _____________________________________

_____________________________________________

Section B[ Programme]

1 Programme for which you are applying:

________________________________________

Expected Start Date:

__________________________________________

2 Kindly indicate the service(s) you require:Assessment Only [ ]

Training & Assessment [ ]

3 Preferred Study OptionFull-Time [ ]

Part Time [ ]

Weekends Only [ ]

4 Have you previously attended Bars To Go Training

Institute? YES (From ______ to ______ )

Programme _______________________________

5 Are you currently enrolled with Bars To Go

Training Institute? YES (From _______to_______ )

Programme


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NO [ ] _________________________________

NO [ ]

6 Do you have access to high speed internet at: Home Work No Access Other

_______________________________

Section C[ Source of Funding]

1 What is your source of

funding?

Self [ ]

Employer [ ]

2 (IN CASE OF SPONSORSHIP FROM EMPLOYER)

Authorising Personnel:

____________________________________

Position:

________________________________________________

Telephone:

______________________________________________

Level of Sponsorship: Complete [ ], Partial Amount

$_____________

Signature:____________________________________________

___

PLEASE AFFIX COMPANY STAMP HERE

Section D[ Educational Background]

High/Secondary School Institution Attended Programme

Pursued

Year Award /Result

College/Other

Institution Attended Programme

Pursued

Year Award /Result


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Section D[ Other Info]

1 Where did you hear about Bars To Go Training Institute?

Radio [ ]

Newspaper [ ]Brochure [ ]

Website [ ]

Word of Mouth [ ]

Other _____________________________

2 PARENT / GUARDIAN CONSENT IF APPLICANT IS UNDER 18 YEARS

Applicants Name:___________________________________________

Name of Parent / Guardian: ___________________________________

Relationship: _______________________________________________

Address: ___________________________________________________

Tel. # (work): _______________________________________________

Tel. # (home): _______________________________________________

Signature: __________________________________________________

Date: ______________________________________________________

1. My signature certifies that I have read understood and agreed to the terms and conditions of this application

including Bars To Go Training Institute Conditions of Enrolment and Refund Policy and further agree to abide by

all the policies, rules and regulations of the institution.

2. I also understand that the Institute reserves the right to suspend or dismiss any student at anytime for

disciplinary misconduct or when such action is deemed to be in the best interest of the student and student

body.

3. I understand that withholding information requested or falsification of information given will result in

cancellation of my application and/or revocation of admission.

4. Ideally, annual tuition fees should be paid in advance, but individuals who are not company-sponsored, or

those unable to make payment in full before the start of the programme (self-sponsored), may make payments

according to our payment option. This arrangement must be made with the Training Institute Administrator. For

payments made according to our payment plan, the first payment must be paid in full before starting

programme.

Methods of Payment


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Payments must be made in cash or certified cheque using the appropriate bank voucher, obtainable at

the Bars To Go Training Institute

Debit Card/ Credit Card

A copy of the bank voucher must be submitted to the Accounts Department as soon as possible after making

any payments. This will facilitate and expedite the accurate update of your student account file.

__________________________________________________________________________

__________________________________________

Applicants Signature Date

FOR OFFICAL USE ONLY

Decision: Full acceptance [ ] Denied [ ]

Certification submitted ________________________________________________________________

Fee received: YES_____NO____

Initials: _____________________

Receipt#: ___________________

BTGTIET Score: __________________

Remarks:____________________________________________________________________________________________

__________________________________________

Training Institute Administrator

_________________________/________________________________/______________

Name Signature Date

Down in My Personal Galaxy Rabbit Bunny

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