Canbourne University Pre-Assessment Evaluation Application Form How does the process work? Prospective students submit this Pre-assessment Application Form for the degree of their choice – BS; BA; MA; MS; MBA; or PhD. Our Educational Assessment Committee will review and evaluate the application. If you can qualify, one of our registrars will contact you by e-mail or by telephone with the results of the evaluation. Please complete this evaluation form as thoroughly as you can so that we can accurately assess your accomplishments. Incomplete forms will not be processed. This assessment is totally free of any charge, and does not obligate you in any manner. This form was originally created for on line use. You may however print it out on your computer, and once it is complete you may fax it to us at 44-207-900-6917 About You Full Name:* ___________________________ Date of Birth:* ___________________________ Gender:* Male / Female Years of Experience (related to your field):* _____ Current Position at Work (e.g. Manager, Secretary, etc.):* __________________________________________________ Years in Current Position: _____ Estimate Your Annual Income:* $ US _____________ Estimate Income with New Degree: $ US _____________ Highest Level of Formal Education Completed:* Elementary School / High School / Associate Degree/ Bachelor Degree / Master Degree / Doctorate Certificates or Other Training Completed: __________________________________________________ __________________________________________________ __________________________________________________ Your Degree Preferences Degree Preference:* High School (from associated institute) Associate (AA /AS) Bachelor (BA / BSc / LLB) Masters (MA / MSc / MBA) Doctorate (PhD / PsyD / EdD / DdD / JD etc.) Other or Additional (please specify below):Preferred Field of Study: __________________________________ Other (please enter other field of study): __________________________________ Briefly Outline the Work / Life Experience That May Qualify You for This Degree: Note: there is no need to falsely your claims. We may call you to review your relevant experience. We rely on you to submit truthful information regarding your experience. __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ Please Describe Any Other Information You Feel May Help You Qualify for the Degree You Seek. (include military experience, volunteer work, etc.): __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ Resume / CV: (If you have a resume, please paste it on the right) -> Your Contact Information International Telephone Code:* ______ City Telephone Code:* ______ Primary Telephone Number:* __________________ Secondary Telephone Number: __________________ Mobile Telephone Number: __________________ Fax Number: __________________ Contact E Mail Address:* ____________________________________ Retype Contact E Mail Address:* ____________________________________ Address:* __________________ __________________ __________________ City:* ___________ County / State / Province / Region / District: ___________ Post Code* ___________ Country* ___________ General How did you hear about this site? __________________________________________________ Agreement Section By pressing the send button, you are aware of and agree to the following: • I certify that I am over 18 years old, and the person who's name appears on this application, and that all the information I have provided is complete and accurate to the best of my knowledge. • I understand that this is a pre-assessment application form that will be forwarded to Canbourne University, if this application meets their standard. I hereby give them the right to call my telephone numbers, as submitted, for any further inquiries. • I understand that withholding information requested, or giving false information, may make me ineligible for admission and enrolment. I understand that if I fabricated any issues herein, I am eligible for prosecution and/or revocation of any degree that may be awarded. • I authorize the Online University Degree program to utilize any and all public means available to verify the information herein. I UNDERSTAND CANBOURNE UNIVERSITY WILL NOT CONTACT MY EMPLOYER OR ANY PREVIOUS EMPLOYER WITHOUT MY DIRECT CONSENT. • I understand Canbourne University admits students of any race, religion, age, sex, colour handicap, sexual orientation and national or ethnic origin to all the rights and privileges, programs, and activities generally accorded or made available to students at the university. it does not discriminate on the basis of race, religion, age, sex, colour handicap, sexual orientation and national or ethnic origin in administrating it's educational policies, admissions policies, or other university administered programs. (Type your name here)__________________________ Signature:________________________ Within 5-6 business days of sending this application, you should receive an acknowledgement form the registrar's office. This form was originally created for on line use. You may however print it out on your computer, and once it is complete you may fax it to us at 44-207-900-6917 Copyright © Canbourne University