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Please ensure that you have read this form carefully. Additional forms can also be downloaded from twofour54.com/tadreeb. If you have difculty accessing our website, or would like to be sent a hard copy, please call us at + 971 2 401 2454 or email us at tadreeb@twofour54.com. Please type or use BLOCK CAPITALS and fax the completed form to + 971 2 401 1229.

Delegate Details
First name Middle name Family name Male Date of birth (dd/mm/yy) Email address Postal Address PO Box House/Apartment Street Zip Code Telephone number Nationality City Country Female

Emergency contact details

Given name Surname or family name Relation to applicant Home phone number Mobile phone number Email address

Course Start Date

Passport Number (please attach copy of passport to this form)

Are you a United Arab Emirates national? If no, do you require a twofour54 sponsored visa?

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No No

Educational Information
Is English your rst language? If no, what is your rst language? Have you completed a study at a secondary or post-secondary education institute that primarily taught in English language? Yes No If yes: Please attach evidence If no: You must demonstrate English language prociency by providing an IELTS test result with a minimum overall score of 5.5 IELTS or 523 TOEFL (paper-based), 193 TOEFL (computer-based) Result of test Type of test ( i.e IELTS or TOEFL) Yes No

(Please attach a copy of these results to this application) Secondary Education Have you completed, or will you complete, 12 years of schooling ( year 12 or A-levels or equivalent) before commencing at twofour54 tadreeb? No Yes If yes: In what year did you, or will you complete year 12 or A-levels or an equivalent qualication? At what school? City Country

Post secondary education Please provide details of your post secondary education (i.e College or University) Year from Year to FT/PT Name of Educational Institute Name of Courses studied, with details or major studied and class of honours (if applicable) Date of completion (or expected DoC)

Employment
Please provide relevant employment history. Year from Year to FT/PT or casual Employer Position and main duties

Signature (applicants or parent / guardian if under 18)

Signed Name 1. I declare that all information I have given in this application is true and correct. 2. I declare that the signature on this form is my signature and has not been signed on my behalf by another person, including my agent or sponsor. 3. I agree to tell twofour54 immediately if there is any change to the information I have given in this application. 4. I understand twofour54 may terminate this application and registration and it may vary or reverse any decision made should it subsequently be discovered that the information provided in support of this application was inaccurate or incomplete or a misrepresentation of my academic and other achievements. 5. I authorise any institution or organisation named on any document provided as evidence of my qualications or work experience to release to twofour54 any personal information which they may hold about me for the purpose of verication of my supporting documents. 6. I authorise twofour54 to release any personal information they may hold about me to any other educational institution from which twofour54 is seeking verication of my supporting documents. Date (dd/mm/yy)

. . twofour54 twofour54 FZ-LLC is a subsidiary of the Media Zone Authority - Abu Dhabi

2454 . . P.O. Box 2454, Abu Dhabi, United Arab Emirates.

t. +971 2 401 2454 f. +971 2 401 1229 e. tadreeb@twofour54.com twofour54.com/tadreeb