Test Pass No ______________

North South University

School of Business

Executive MBA Program

Plot 15, Block B, Bashundhara, Dhaka-1229, Bangladesh. Tel: 8852000, Fax: 8852016

APPLICATION FOR ADMISSION

North South University (NSU) is committed to the principles of equal opportunity and is open to all candidates with
required academic qualifications. There will be no discrimination on the basis of age, race, sex, religion,
nationality, social groupings, etc.
Please cross mark (x) the appropriate boxes, where necessary:

Application for admission in:

Spring (Jan Apr)

Fall (Sep Dec)

1.

Year

Name (in block letters):

_____________
First Name
Date of Birth
Day
Male

2.

Summer (May Aug)

______________
Middle Name

____________
Last Name

_____________
Other Name

_______ _________ ______ ______________ ___________

Month
Year Place of Birth Citizenship
Female

Married

Please affix
two passport
size
photographs
here

Single

Information about father/husband:

(a) Name:
________________________________________________________________________________
(b) Occupation & Position: __________________________________________________________________
(c) Work address: _________________________________________________________________________
_________________________________________________________________________
(d) Telephone: ______________________
Home

______________________
Office

______________________
Mobile

INSTRUCTIONS
a. The application processing fee of Tk.1000 (US $15.00 for overseas applicants) is nonrefundable. The final
decision regarding admissions will be based on the candidates academic background and performance in
the admission test/interview. The decision of the EMBA Admission Committee shall be final.
b. Applications will not be processed without a Complete Application Package which includes (1) completed
application form, (2) three passport size photographs of the applicant, (3) one set of all certificates and
mark sheets/ transcripts (attested), (4) one set of appointment letters and experience certificates (attested),
and (5) visiting cards of the candidate and the supervisor.
Do not write in this area
Degree
Non-Degree

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Accepted conditionally
Not acceptable

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3.

Mothers Name: ___________________________________________________________________________

Mothers Occupation & Position: ______________________________________________________________

4.

5.

6.

Mailing Address:
_____________________________________________________
House / Apt #
Street/Road

_______________________________
Village & P.S.

_____________________________________________________
District/City
Post Code

_______________________________
Country

Permanent Address:
_____________________________________________________
House / Apt #
Street/Road

_______________________________
Village & P.S.

_____________________________________________________
District/City
Post Code

_______________________________
Country

Office / Business Address: ___________________________________________________________________

_________________________________________________________________________________________

7.

Telephone:

______________________
Home

______________________
Office

Fax : ______________________________
8.

______________________
Mobile

E-mail : _____________________________

List the schools, colleges and universities you attended (begin with most recent degree):

Degree /
Exam

Name of Institution

Board/
University/
Country

Year of
Passing

Group /
Major Area

Class /
Division/
CGPA

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9.

Are you a Dependent?

Yes

Who will pay your tuition and fees?

No
Self

Company

Parents/Spouse

Other

If Other, please give details below:

Name: ___________________________________________________________________________________
Mailing Address: ___________________________________________________________________________
_________________________________________________________________________________________
Telephone:

______________________
Home

______________________
Office

Fax: ______________________________

______________________
Mobile

E-mail: ____________________________________

Relationship with sponsor: ___________________________________________________________________

10. Work Experience (begin with most current job):
Organization & Address

Position/Title

Supervisors Name &

Telephone

11. Have you ever been dismissed, suspended or expelled from any academic institution?
Yes

No

If yes, describe briefly or attach a statement.

Dates
(From To)

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12. Were you admitted into any academic program of NSU before?
If yes, state ID# and date of admission.

Yes

No

13. I hereby accept that if admitted to North South University, I will be bound by the rules and regulations of the
university and the NSU Student Code of Conduct.
I accept that manufacture, distribution, possession and consumption of tobacco products, alcohol, drugs
and controlled substances are strictly prohibited in NSU premises and that I may be expelled for
violating this rule or for abetting violators.
I agree that withholding information requested in this application or giving false information will make me
ineligible for admission into NSU and liable to be dismissed if admitted. I hereby certify that the above
statements are correct and complete to the best of my knowledge.

_____________________
Date

_____________________________
Signature of Applicant

Note: The application will not be processed unless signed.

Date of admission test /interview:

Test Pass No. ________________

Please complete the following:

Name: __________________________________________________________
Address: ________________________________________________________
________________________________________________________________
Phone: ___________________________________________________________

Please affix
a passport
size
photograph
here