AVU Student Application Form

Page 1 of 5

AVU Student Registration Form

The African Virtual University Cape Office Park Ring Road, Kilimani PO Box 25405 - 00603 Nairobi KENYA		L'Université Virtuelle Africaine Sicap Liberté 6 extension VDN villa no 8 B.P. 50609 Dakar SENEGAL
Registration Form (page 1 of 5) All Fields marked with an asterisk *()** are mandatory

Application Instructions

- The Student's Registration Form is five pages long and it should take you approximately 30 minutes to complete.
- Please note that there is a 10 USD application fee required and payment options will be made available to you after of this form.
- Ensure to fill in all the fields marked with an asterisk (*).You will receive an electronic copy of the form for your records upon submission.

Please have the following information before hand.

1. Details of your most recent qualifications.

(a) Name of Degree(s)/Diploma(s) (b) Period (c) Institution Name, City, Country	(d) Department (e) Grade attained

2. List of prizes, distinctions, scholarships and publications (if any).

3. Details of your Work Experience (if applicable)

(a) Period (b) Department	(c) Name of organization, City and Country (d) Job Title
Note: You may provide work experience details of up to 3 job positions held

4. Indicate 3 persons (teachers or employers) that may provide references for your application. Include: Name, Position, Institution, Telephone number and Email Address.

5. Choice of AVU Programs/Courses

6. Prepare the following documents for upload. Formats allowed (JPG, GIF, PNG, TIFF, DOC, DOCX, PDF)

(a) 1 digital passport size picture (b) Your Complete and up-to-date CV (c) Certified copies of your diplomas and degrees	(d) A cover letter explaining the purpose of your application and reasons for applying (e) Any other document that you wish to attach
Incomplete applications will not be considered

Registration Period(*)

Please select Registration Period
Year(*)

Please Select Year
AVU Office Applying To(*)

DakarNairobiPlease select AVU Office that you are applying to
Former AVU student?(*)

YesNoPlease select one
If Yes, which program and year?

Invalid Input
AVU Student ID number, if any

Invalid Input
1. APPLICANT INFORMATION
Last Name(*)

Please enter Last Name
First Name(*)

Please enter First Name
Gender(*)

MaleFemalePlease select Gender
Date of Birth (dd/mm/yyyy)(*)

Please enter Year of Birth
Place of Birth(*)

Please enter Place of Birth
Nationality(*)

Please enter Nationality
Address(*)

Please enter Address
City(*)

Please enter City
P.O. Box

Please enter P.O. Box
Country(*)

Please select Country
Mobile Number(*)

Please enter Mobile Number
Telephone

Please enter Telephone Number
Fax

Invalid Input
Email(*)

Please enter Email in the correct format

The African Virtual University Cape Office Park Ring Road, Kilimani PO Box 25405 - 00603 Nairobi KENYA		L'Université Virtuelle Africaine Sicap Liberté 6 extension VDN villa no 8 B.P. 50609 Dakar SENEGAL
Registration Form (Page 2 of 5) All Fields marked with an asterisk *()** are mandatory

2. ACADEMIC RECORD
(a) Education
Education (most recent qualifications obtained/enrolment in ongoing programs) or relevant experience and employment, if any
Period
From (mm/yyyy)(*)

Please Enter date
To (mm/yyyy)(*)

Please Enter Date
Institution, City, Country(*)

Please enter Institution, City, Country
Department(*)

Please enter Department
Degree or Diploma or Job Obtained(*)

Please enter Degree or Diploma Obtained
Grade(*)

Please enter Grade
Period
From (mm/yyyy)

Please Enter date
To (mm/yyyy)

Please Enter Date
Institution, City, Country

Invalid Input
Department

Invalid Input
Degree or Diploma or Job Obtained

Please enter Degree or Diploma Obtained
Grade

Invalid Input
Period
From (mm/yyyy)

Please Enter date
To (mm/yyyy)

Please Enter Date
Institution, City, Country

Invalid Input
Department

Invalid Input
Degree or Diploma or Job Obtained

Please enter Degree or Diploma Obtained
Grade

Invalid Input
Prizes, Distinctions, Scholarships and Publications

Invalid Input
(b) Work Experience
Period
From (mm/yyyy)

Please enter Date
To (mm/yyyy)

Please enter Date
Institution, City, Country

Invalid Input
Department

Invalid Input
Job Title

Invalid Input
Period
From (mm/yyyy)

Please enter Date
To (mm/yyyy)

Please enter Date
Institution, City, Country

Invalid Input
Department

Invalid Input
Job Title

Invalid Input

The African Virtual University Cape Office Park Ring Road, Kilimani PO Box 25405 - 00603 Nairobi KENYA		L'Université Virtuelle Africaine Sicap Liberté 6 extension VDN villa no 8 B.P. 50609 Dakar SENEGAL
Registration Form (Page 3 of 5) *All Fields marked with an asterisk () are mandatory**

3. LANGUAGES
Your Level in English, French and Portuguese
English:
Spoken

Invalid Input
Written

Invalid Input
French
Spoken

Invalid Input
Written

Invalid Input
Portuguese
Spoken

Invalid Input
Written

Invalid Input
Other Languages

Invalid Input
4. REFEREES
Indicate at least three persons (teachers or employers) that may provide
references for your application
Name, Position, Institution, Tel(*)

Please Enter Referee details
Name, Position, Institution, Tel(*)

Please Enter Referee details here
Name, Position, Institution, Tel(*)

Please Enter Referee details
5. SCHOLARSHIP
Have you recieved a scholarship for this program?

Please Select One
If yes, from which organization

Invalid Input
What Amount?

Invalid Input

The African Virtual University Cape Office Park Ring Road, Kilimani PO Box 25405 - 00603 Nairobi KENYA		L'Université Virtuelle Africaine Sicap Liberté 6 extension VDN villa no 8 B.P. 50609 Dakar SENEGAL
Registration Form (Page 4 of 5) *All Fields marked with an asterisk () are mandatory**

6. CHOSEN PROGRAMS AND COURSES
Enrolment(*)

Entire ProgramCourse(s) OnlySelect Entire Program or Course(s) Only

Select Program

Please Select Program
Certificate/Diploma or Degree Program

Please Select Certificate/Diploma or Degree Program

Courses
Select your courses and click the Add button
How to Select Courses
Subject

Please Select Course
Select Course and Click Add Button

Invalid Input
Your Course Selection:

Please Select Your Course
Invalid Input

The African Virtual University Cape Office Park Ring Road, Kilimani PO Box 25405 - 00603 Nairobi KENYA		L'Université Virtuelle Africaine Sicap Liberté 6 extension VDN villa no 8 B.P. 50609 Dakar SENEGAL
Registration Form (Page 5 of 5) *All Fields marked with an asterisk () are mandatory**

7. FILES
Upload the Following Documents with this Application
1 digital passport size picture(*)

Formats allowed: JPG, GIF, TIFF, DOC, DOCX, JPEG, PNG, DOCX, PDF
Your Complete and up-to-date CV(*)

Formats allowed: JPG, GIF, TIFF, DOC, DOCX, JPEG, PNG, DOCX, PDF
Certified copies of your diplomas and degrees(*)

Formats allowed: JPG, GIF, TIFF, DOC, DOCX, JPEG, PNG, DOCX, PDF
A cover letter explaining the purpose of your application and reasons for applying(*)

Formats allowed: JPG, GIF, TIFF, DOC, DOCX, JPEG, PNG, DOCX, PDF
Any other document that you wish to attach

Documents formats accepted DOC, PDF, JPG, JPEG, docx, pdf, GIF, TIFF

Incomplete applications will not be considered.

I cerify that the information contained in this application is accurate and complete
I hereby agree to pay the registration fees and I am aware that I will be indebted to the African Virtual University (AVU) for any unpaid fees, unless I notify the AVU (by letter or email) of my intention to cancel my registration prior to the deadline for full refunds, as specified by the AVU administration

Please note that the AVU reserves the right to refuse admission or to terminate a student's attendance should it be discovered that he/she has made a false statement or has ommitted significant information. If you are selected you will be required to provide evidence proof of your qualifications

Do You Accept?

YesNoInvalid Input

Names(*)

Please enter your full names
Place(*)

Please enter place
Date Submitted(*)

Please select Date Submitted

Africa Virtual University - AVU

Application Instructions

Students