Recognition of Qualifications Application Form

1. Personal Details of The Qualification Holder

Name(Required)

Title First Middle Last

Maiden name N/A if not Applicable

Date of Birth(Required)

Nationality(Required)

Gender(Required)

Male

Female

Residential Address(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Home Telephone(Required)

Mobile Telephone(Required)

Work Telephone(Required)

Email(Required)

Fax Number

2. Personal Details of Contact Person

(applying on behalf of the qualification holder (if applicable)

Title

Initials and Surname

Relationship with Applicant

Residential Address

Street Address City County / State / Region Country

Fax Number

Home Telephone

Mobile Telephone

Email

3. Purpose of the Application

PURPOSE OF THE APPLICATION(Required)

General Employment

Professional registration/licensing

Further study

Other (please specify)

Evaluation required for (tick all that apply)

Provider Name(Required)

Qualification Title(Required)

Others(Required)

4. Information Regarding the Qualification

Name of Education or Training Institution(Required)

Web address(Required)

Email address(Required)

Phone(Required)

Postal address(Required)

Status of Educational Institution(Required)

Private

Public

Name of Awarding Body(Required)

(if different from Education or Training Institution)

Web address(Required)

Email address(Required)

Phone(Required)

Title of Qualification in original Language(Required)

(if other than English)

Title of Qualification in English(Required)

Specialization/main field of study(Required)

Date Started(Required)

Date Completed(Required)

Study Mode(Required)

Length of Programme of study(Required)

(according to curriculum)

Date of awards(Required)

Contact details of official at institute who can supply further details about the course of study (E.g. Registrar, Principal, Dean, etc)

Name(Required)

Prefix First Last

Address(Required)

Street Address City County / State / Region ZIP / Postal Code Country

Email Address(Required)

Phone Number(Required)

5. Additional Information Regarding the Qualification

Did the programme of study include a research paper/thesis?(Required)

Yes

No

What was the title of the paper/thesis?(Required)

Duration of Paper/Thesis work? (number of weeks)(Required)

Did the programme of study include a work experience component?(Required)

Yes

No

Contact details for where the work component took place (E.g. Manager, Principal, CEO)

Name(Required)

Prefix First Last

Address(Required)

Street Address City County / State / Region ZIP / Postal Code Country

Any further information relevant to establishing comparability of your qualification e.g. study periods at another institution, Credit granted on the basis of another award etc.(Required)