Applicant Name: _______________________________________ Desired Entrance Date: Semester : Year :

email : info@uigb.org web site: http://www.uigb.org Office Hours 08:30 – 17:30 Monday through Friday 04 BP 1062 Abidjan 04, RCI telephone (225) 22.41.30.41/ 21.30.36.40 Fax (225) 21.30.34.83

Applicant Name: _______________________________________ Desired Entrance Date: Semester : Year :

Application Form

Picture of Applicant
Color 1.5 x 1.25 in or 38 x 32 mm

For office use only : Date of Interview ___________________ Decision ___________________ Method of payment ___________________ Name/Title __________________________ Signature __________________________

Date ___________________________ Proof of payment verification by Business Office Name/Title ____________________ Signature ____________________ Date ___________________________

Program Requested (Degree or Certificate Sought) Department of Interest after preparatory year Check one (Non-binding choice at this time.) • Business Administration • Computer Science • International Relations and Strategic Studies • Non-degree program (specify course) ___________________ Date of last application to IUGB (Semester/Year) _____________/___________ Dates of previous attendance at IUGB (Semesters/Years)__________/__________ Full name of applicant (This is your legal name and the way your name will appear on any certificates or diplomas earned.) _________________________________________ _________________________________________ Full maiden name__________________________ Date of birth (D/M/Y) _____/_____/_____ Nationality(ies) (other if any)_________________ ID Document Type (National ID, passport or travel document) Circle one or list other______________ Attach a photocopy of the document named. Bring the original for verification when submitting the completed form. Give the Number on the document named above._____________________ Expiration Date of ID Document (must be valid for a minimum of a year from the