SECTION A: PERSONAL DETAILS (USE BLOCK LETTERS)
I.D. Card No. _______________________ Gender: Male Female
Surname*: ________________________ Name*: ______________________________
Maiden Surname: ___________________ Date of Birth: ___/___/___ Age: ________
dd mm yyyy
Nationality: (1) ___________________________ (2) _____________________________
Address:
House No.: ___________________________
Street: ___________________________
Town: ___________________________
Postcode: ___________________________
Country: ___________________________
Affix original recent passport photograph here
Home Tel. No.: ___________________________
Work Tel. No.:
Mobile No.:
___________________________
___________________________
Email Address: ___________________________
* This is the name that will be shown on your transcript.
Section B: PROMOTIONAL MATERIAL AND QUESTIONNAIRES
The Registrar receives requests to forward emails on behalf of University of Malta / Junior College staff / students, Senate recognised students' organisations related to activities being organised, questionnaires required for research etc.
Would you agree to receive such material? Yes, I agree No, I do not agree
Section C: NEXT OF KIN
Surname: _________________
Address: Same as Applicant?
Name: _______________
Yes No
If No, please specify: _____________________________________________________________________
____________________________________________ Postcode: _____________
Telephone/Mobile No.: ____________________
Relationship to Applicant: ________________
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Section D: DISABLED APPLICANTS / MEDICAL CONDITION
Do you have any disability that the University of Malta should be aware of? Tick  as appropriate
Yes No

If yes, please specify: Hearing Impairment
Mobility Impairment
Specific Learning Difficulty
Visual Impairment
Other ___________________________________________________________
Please let us know if you have any particular requirements due to a disability or a long term condition.
This information will be used to enable us to provide you with appropriate help and services to facilitate your studies at the University.
Section E: ADDITIONAL INFORMATION
 Application forms must be handed in personally to the Admissions and Records Office (Room 113,
Administration Building), University of Malta.
 Together with their application, applicants must submit a Curriculum vitae in Europass format, together with a letter of motivation for following this study-unit.
 A fee of €850 is payable.
Section F: STATEMENT OF INTEGRITY
It is important to read carefully the statement below before ticking the box.
I declare that the information given is correct and complete at the time of submission of this application. I bind myself to produce original certificates and proof of payment of the application fee by the date indicated to me. I hereby authorise the University of Malta to request and obtain any information from any institution, entity, body, unit, organ and/or organisation, provided this information is considered necessary by the University of Malta for the purposes of this application. The University of
Malta reserves the right to withdraw or amend any offer made or terminate any subsequent registration should the information given in the application be found to be incorrect.
I am aware that my personal data may be used as follows: for internal business processes of the University, research purposes, as required by the Laws of Malta or in cases where in the opinion of the Registrar it is in my interest to do so. Computer and paper records are kept about each student’s studies, both during the course and after completion of studies.
____________________________
Applicant’s Signature
___________________________
Date
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