Title Male(M) / Single(S) / Date of Birth Age on Female(F) Married(M) (DD/MM/YY) Jan 1, 2018 Surname / Family Name Forename(s) / Given Name(s) Postal / Physical Address City / Main Town Phone Province / Mobile State Phone Country NRC/Passport Number E-Mail Address Nationality Country of Birth In case of emergency, whom should we contact: Relationship (The Contact Person is My) Surname / Mobile Family Name Phone Forename(s) / NRC/Passport Given Names(s) Number Postal Address City / Town Province / Country State Medical Information Please check Yes or No for the following questions. If Yes is checked, please explain in the space provided.

Do you regularly take any medication? If so, please explain: Do you suffer from any medical condition or disease which may affect your ability to attend classes? If so, please explain: Do you have any disabilities or special needs (including dyslexia, are you deaf or blind, wheelchair bound, etc.). If so, please explain: Have you had any criminal convictions? If so, please explain: Do you have any dependents? If so, please indicate their Names and Current Ages:

Name Relationship Age Name Relationship Age

Yes No

1. Personal Information

- - D D M M Y Y

Application for GAP Semester Academic Year 2018

Deadlines for Submission:

January Intake— 12th January

P.O. Box 240271 | Ndola, Zambia | Tel: 260-212-622-195/6 | Mobile: 260-976-622-196 Website: www.northriseuniversity.com | Email: apply@northrise.net

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TO BE FILLED IN BY HIGH SCHOOL GRADUATES

AWAITING G12 RESULTS ONLY:

If you wish to apply for

A-Levels or a Degree program, please use the

Application for Admission Form

Secondary and Higher Education Part Time or From To Level, Certificate, Overall Diploma or School Name Full Time Month Year Month Year Degree Obtained Grade

Application for GAP Semester Academic Year 2018

2. Education (High School Details)

3. Employment

List your current or most recent employment first Nature of From To Name of Reason for Name of Organization Work Month Year Month Year Last Supervisor Termination

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4. Who is Financing your Education? Indicate the address information of your sponsor in the space below.

b. Details of Your Current Job and Responsibilities (If Applicable)

Describe your responsibilities below:

Industry Sector: Nam of Organization:

Name of Supervisor Start Year/Month:

Position :

5. Payment Plan

Please read the Payment Plan information under Appendix A of this application form and indicate by ticking which plan would be suitable for you:

Full Names/Org Name:

Working Email Address: Mobile Number(s)

Postal Address:

NRC Number:

Relationship with Sponsor (Who are they to you) :

Full Tuition (FT) Half Course (HC) Prorated Payment Plan (PPP)

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N Application for GAP Semester

Academic Year 2018

5. Applying For (Gap Semester)

The following courses are being offered for Academic Year 2018 Gap Semester

I wish to take all courses being offered under the Gap Semester I wish to take selected courses under the Gap Semester

Courses being offered under the Gap Semester

Admin Use Only

Please Tick (Check) the Courses you wish to be enrolled

CIT101—Computer Literacy Basics ENG101—English Grammar

c MAT101—Intermediate Algebra ENG103—Social Issues

HUM104—Zambian Studies

Please write a personal statement concerning your career goals and how your Northrise University education would facilitate achieving those goals. Note: If applying for postgraduate program, please give an assessment of your personal strengths and weaknesses and state how you t hink your program of choice at NU will assist with your development (400 words).

6. Personal Statement (all applicants must complete this section)

(If you choose this option, please indicate below which specific courses you wish to take)

Application for GAP Semester Academic Year 2018

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Declaration:

I confirm that the information given on this form is true, complete and accurate, and no information requested or other material information has been omitted. I have read the entire Application for Admission document. I undertake to be bound by the terms set

out in it and I give my consent to the processing of my data by Northrise University. I accept that my failure to provide complete, accurate, and truthful information on this application will be grounds to deny or withdraw my admission, or dismiss me after

enrollment; Northrise University shall have the right to cancel my application and I shall have no claim against Northrise University.

Applicant’s Signature: Date: Please photocopy this application and keep a copy for your records. Submit your Grade 12 mock results and any other qualifications together with a copy of your NRC and/or passport including 2 passport size photos by the

applicable application due date indicated on the first page of this application form.

DISCLAIMER: An advance payment for Application Form before form is submitted for scrutiny of correctness and completeness shall NOT be refunded

Obtain Further Information at any Stage in the Reapplication Process:

To obtain more information concerning your admission process, deadlines related to the Application for Admission process, and details of all programs offered visit our website at http://www.northriseuniversity.com. You can also send an email to

apply@northrise.net. Alternatively, you can reach us on Tel.: +260 212 622 195/6 or Mobile at +260 976 622 196

7. Referred To NU By

8. Accommodation

I wish to apply for Accommodation

Please indicate whether you wish to apply for accommodation NOTE: ( Accommodation is limited and first offered to NU Students) You can apply but consideration is based on space available after NU students are served.

Note: Please note that this is just an indication of interest and NOT an actual application for accommodation. Please, fill in the appropriate forms included in the acceptance packet upon acceptance.

Surname:

First Name:

If you were referred to Northrise University by a student or staff, please indicate their details

NU ID:

Student

Staff

Other Referrals (Choose one and state the specific Name besides your choice)

Radio ___________________

TV _____________________

Website/FB __________________________

Other _______________________________

2. Tuition Payment Plans

1. GAP Semester Entry Requirements

Awaiting G12 Results: School leavers who are awaiting G12 results require the following for enrolment:

1. Grade 12 Mock Results (MUST have obtained 5 Credits or better, inclusive of English and Mathematics)

2. Testimonial from High School

Re-sitting G12: School leavers with G12 results but do not meet minimum entry requirements (5 credits or better inclusive of English and Mathematics) may apply with their G12 statement of results and a recommendation letter.

Application for GAP Semester Academic Year 2018

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Appendix A

Northrise University offers two (3) payment plans to GAP Semester Students giving them alternatives in the way they pay for tuition fees,

thereby help ease the financial pressure. To avoid inconvenience, please plan ahead of time so that by the payment due date - based on the

payment plan chosen (see below) - your tuition fees would have already been paid. Contact the accounts office at accounts@northrise.net for

details of the following payment options offered:

Full Tuition (FT) Payment Plan

GAP Semester students pay the full semester tuition at the beginning of the semester .

Half Course (HC) Payment Plan Students pay half of the tuition fees for the course(s) plus “other fees” at the beginning of the course.

For GAP Semester students, the second half should be paid by the end of the 7th week of the course respectively. If you choose

this option, please carefully understand the terms and conditions of the payment plan.

Prorated Payment Plan The Pro-Rated Payment Plan (PPP), allows a GAP student to settle their tuition fees in Three (3) installments as follows;

First Installment: 34% of total (Courses Fees plus Mandatory Fees) should be paid at the beginning of the Semester

Second Installment: 33% of total (Course Fees) should be paid by the end of the 5th week

Third Installment: 33% of total Course Amount Due should be paid by the end of the 10th week .

NOTES:

Please note that if a student fails to pay by the respective dates, they cannot continue with the course(s). The fees

paid so far will cover the classes attended to this point and those course (s) would need to be redone at the regular

rate or fee.

Students are free to change to another Payment Plan at the beginning of a new Semester

Find more information about the Accommodation policy, please visit our website: http://www.northriseuniversity.com

3. Accommodation Policy

Find FAQs in the Fees and FAQs brochure inserted or on our website: http://www.northriseuniversity.com

4. Frequently Asked Questions (FAQs)

Application for GAP Semester Academic Year 2018

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The following are the bank details for Northrise University: Please return deposit slip as proof of payment to NU for receipting.

Bank Name: Standard Chartered Bank

Account Name: Northrise University

Branch: Ndola, Buteko

A/C. No.: 01504-3030-1300

Swift Code: scbzmlxaxxx

Note : If you choose to use the bank to pay your application fee or any other fees, please see sample deposit slip on our

website

4. Bank Details

Appendix B

Once you have completed filling in this form, you can scan and email it to apply@northrise.net or you can fax it to +260 212 622198. Al-

ternatively, you can bring it in person to the NU offices or mail it immediately to the following address:

The Recruitment Manager

Northrise University

Caravelle House, Buteko Avenue

P. O. Box 240271,

Ndola, Zambia

8. How to Send this Form Back to NU

2. Application Checklist

To complete your application, please indicate whether you have understood the information and append your signature and date at the bottom to allow NU to process your application

I have understood the following information and filled in the relevant forms where applicable

Application Form

Payment Plan

Accommodation Form

Minimum Class Size Policy

Tuition Fees Information

I have read and understand the overall NU Core Values

Applicant’s Signature: Date:

NU is a Christ-centered university. Students are required to attend chapel at least 80% of all the times that chapel is held in each Semester. In addition all our classes begin with devotions and prayer based on the Holy Bible. Students are also required to abide by our core values which are based on biblical principles. Please familiarize yourself with our core values in the Student Handbook found on our website: http://www.northriseuniversity.com

1. NU Core Values