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Please download this application form and return the completed form to:
Republic of Yemen
Al Hadeitha Co.
Sana’a, Hadda City
Faj Attan Street
infront of Azal University


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Academics
Preferred academic program    

Student Details
Full Name
Date of Birth
Place of Birth
Nationality
Passport Number
Gender
Martial Status
Mailing Address
C/O:
P. O. Box
City:
Country
Mobile
Email  

Parents/Guardian Details
                                                                     Please provide us with details about your Father/Mother/Guardian:
Name
Profession
Telephone Home
Telephone Work
Fax
Mobile
Email  
Relationship

General Undergraduate Admission Requirements
List the secondary school from which you graduated and any universities you have attended with dates of attendance:
Name of School/University          Location (Country)         Dates of Attendance
        
        
Indicate type of secondary certificate you hold or expect to receive and the date received:
Other (Specify):   
If the certificate is the British IGCSE, GCSE, GCE, the IB Diploma, or similar, specify subject, level and result.
Subject            Level           Result           
                                 
For students applying to EIU, International Internet based TOEFL (61), or Academic IELTS (5.0) is required. Please specify the test you intend to take or have already taken in the space below:
                                                                                               
Those who do not meet the English proficiency stated above are required to take the placement test at EIU to determine their placement in the intensive language levels offered
Do you have any physical disabilities? (This information is voluntary and confidential; it is requested to help the University provide aid and support, as much as possible.)
Other (please explain):
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