GALEN UNIVERSITY

APPLICATION FOR ADMISSION

Please complete and return the completed application form and additional documents to the
Office of Admissions, Galen University, P. O. Box 177, San Ignacio, Cayo, Belize. Attach a
check or money order for $60 BZD or $30 USD payable to Galen University. This fee is non
refundable. Attach 2 recent passport size photographs.

_____________________________________________________________________________
_

Galen University is committed to the principles of equal opportunity in education. The

University does not discriminate against individuals on the basis of race, color, sex, sexual
orientation, religion, disability, age, ancestry, or national or ethnic origin in the administration of
its educational policies, admission policies, employment policies, and other University
administered programs and activities.

NAME: _____________________________________________________________________
Last First Middle

I am entering as: Undergraduate Undergraduate-Transfer Graduate

Full-time Part-time
Day Evening Weekend

For which program: _______________________________________

In the following term: Spring 2008 Summer 2008 Session I

Summer 2008 Session II Fall 2008

_____________________________________________________________________________
FOR OFFICIAL USE ONLY – Please do not write in this section
Amount Receipt No. Date
Application Fee ________ __________ _________
Credit Eval. Fee ________ __________ _________
Tuition Deposit ________ __________ _________

High School Grade _________________ Admission Status _________________

Student Number _________________
 I. PERSONAL DATA

Permanent Home Address ________________________________________________________

Permanent Email __________________@______________ Telephone:____________________

Social Security Number /Other National I.D.# ____________________________________

Date of birth __________________ Place of Birth ______________________________

Sex: Female Male Nationality_________________________________

Country of Residence _________________ Country of Origin _____________________

Primary language ____________________ Language spoken at home ________________

II. EDUCATIONAL DATA

Please list in chronological order (starting from most recent) all schools (Secondary, College,
University) you have attended or are currently attending. An official or certified/attested English
translation of certificates, diplomas, degrees, transcripts (marksheets) or any other supporting
documents must accompany this application or be received before your application will be
considered.

Academic Record
(A official transcript must be received from each institution prior to Admissions Committee Review)
Institution Dates Location Major Degree(s) earned
Attended* City & Country

*All foreign transcripts must be evaluated, on a course-by-course basis.

III. EVIDENCE OF PROFICIENCY IN ENGLISH

Please indicate if you have ever taken any English examinations (such as TOEFL, GCE/GCSE,
IELTS). Attested copies of official results must be supplied, and either accompany this
application or be forwarded as soon as received.

Examination taken: ____________________ Result____________________ Date___________

Examination taken: ____________________ Result____________________ Date___________
IV. OTHER QUALIFICATIONS
Please list any other qualifications (GCE, LCCI, etc.) obtained by examination.
Certified/attested copies of official results must accompany this application.

Subjec Board or Examining Body Grade/Result Examination Date

t

V. APPLICATION INFORMATION
Please indicate the source (s) and reason(s) that led you to apply to Galen University.
Sources
High School Counselor/Teacher
Friends
Galen University student or graduate
Advertisement:_________________
Internet/Website
Education Fair
Other:________________________
Reasons
Reputation
Possibilities to transfer to U.S.A./U.K.
Qualifications to be attained
Reasonable tuition and fees
Safety/Security
Other:_________________________

VI. CERTIFICATION
I have read, understand and agree to comply with Galen University application instructions. I
certify that the information in this application and associated materials is current, complete, and
accurate to the best of my knowledge. I understand that withholding information requested in the
application or giving false information may make me ineligible for admission to or continuation
in Galen University.

Applicant’s signature____________________________ Date:___________________________

VII. PAYMENT

I am paying my application fee (US$ 30): cash (on site only) by check enclosed
by money order
by credit card (please fill the section hereunder)

Credit card type: Visa Mastercard Am. Express Discover

Name on the card: _____________________________________
Card Number__________/__________/__________/__________
Exp. Date: ______/______

Signature of the card holder ________________________ Date:_________________________

You are required to submit the following items in order to
apply for admission:
1. The Application Form
Complete this form and submit it with a non-
refundable fee of $60BZD or $30 USD.
2. Photographs
Enclose two (2) recent passport-size photographs.
3. Academic Records
Enclose official or certified/attested English
translation of:
• High (secondary) School Leaving Certificate, or
equivalent for undergraduate studies
• Bachelor’s degree, or equivalent qualification, for
graduate studies
4. Other Qualifications
Enclose other official or certified certificates or
examination results
5. Transfer Students
Applicants who wish Galen Univ. to accept
transfer work completed at other
colleges/universities must submit official
transcripts and course descriptions of syllabi in
English. The above must be accompanied by a
non-refundable Credit Evaluation Fee of $60
BZD or $30 USD. This amount is in addition to
the Application Fee.
6. English Language Proficiency Test
All students whose secondary or post-secondary
schooling was conducted in a language other than
English, must enclose official results of TOEFL,
GCE/GCSE ‘0’ Level English or IELTS.
FOR INTERNATIONAL STUDENTS
7. Bank Statement of Financial Support
Enclose an original Bank Statement of Financial
Support indicating that your financial sponsor (i.e.
only next of kin) has the ability to finance your
tuition and living expenses for the academic year.
The bank statement must clearly state your name.
8. Passport Copies
Enclose copies of all pages (even blank one) of
your passport. The expiration date of your
passport must be at least one year in the future.
FOR GRADUATE STUDENTS
9. Letters of Reference
Enclose two (2) letters of reference from
professors familiar with your work.
IMPORTANT NOTE
The Office of Admissions will not process any
Application for Admission unless all required
documents, as listed above, are submitted.
English is the language of instruction at Galen
University. All applicants are required to take the
Galen University English Placement Test (EPT),
which will determine the level of English they will
enter and the number of other courses they will be able
to take.
CHECKLIST
Please ensure that all documents listed below
are attached to this form:
Application Fee ($60 BZD or $30 USD)
Passport photos (2)
Transcripts (high school and/or university)
Bachelor’s degree
English Language Proficiency Evidence
International Students Only
Bank Statement of Financial Support
Copy of Passport
Graduate Students Only
Reference Letters (2)
This application will become a part of your permanent
record at Galen University. It should be completed and
returned with all necessary documents to:
The Office of Admissions
GALEN UNIVERSITY
P. O. Box 177
San Ignacio, Cayo
Belize
For information please phone, fax or email:
Tel: + 501-824-3226
Fax: +501-824-3723
Email: admissions@galen.edu.bz
Website: www.galen.edu.bz