Wesley Junior College Application Form
Personal Data
Last Name
First Name
Middle Name
Home Address (Number , Street , City/Town , District)
E-mail Address
Home Phone
Cell Phone
Work Phone
Birth Date
M / D / Y
Country Of Birth
Age
Gender
Male
Female
Citizenship
Belizean National
Permanent Resident
Other
Religion
Methodist
Anglican
Catholic
Evangelican
Other
Marital Status
Single
Married
Common Law
Divourced
Separated
Widowed
Employer
Job Title
Years Employed
In case of Emergency
Emergency Contact (First Name, Last Name)
Contact Address (Number Street City/Town, District)
Contact Home Number
Contact Work Number
Contact Cell Number
For Official Use Only
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Transcript Received?
Yes
No
Application Complete?
Yes
No
2 Recommendation Forms?
Yes
No
Transfer Student?
Yes
No
Date Application received
D / M / Y
Accepted Into
Date of Admission
D / M / Y
Program of Study
Kindly indicate the program of study you are applying for, using 1, 2, and 3 to denote order of preference
Associate Degree Programs
Business Studies
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Paralegal Studies
Information Technology
Social Science
History, Economics
General Studies
With History Major
General Studies
Without Major
General Studies
Without Major
Other Programs
Continuing Certificate Education(1yr.)
Certificate in Computer Repair & Maintenance
Educational Background
High Schools Attended ( List high school(s) attended, separated by commas )
Years Attended (List years respective to the listing of high schools attended )
Graduation Date(s) (List dates respective to the listing of high schools attended )
List the Subjects, Profficiency, and Grades you obtained or plan to take in the CSEC exams sponsored by CXC
Year, Subject, Proficiency, Grade
Math ATLIB (State Date and Grade)
Type N.A if not applicable
English ATLIB (State Date and Grade
Type N.A. if not applicable
Have you ever been involved in major trouble at your school or with the police?
Yes
No
If Yes, Please Eplain, If No, type not applicable.
Consent (I confirm that all the information provided in my application is factual and accurate. I acknowledge that my admission and registration may be cancelled if this information is found to be false. I agree to abide by the regulations and policies of Wesley Junior College. )
Signature of Applicant
Date
M / D / Y
Personal Statement (Please provide a short statement explaining why you wish to study at Wesley Junior College. Kindly use the space provided to neatly write the statement or attach a separate typed page.)
Type Personal Data
MISSION STATEMENT “Wesley Junior College, guided by Christian principles, is dedicated to providing post secondary education that serves as a spring board for further study and seeks to influence its graduates towards positive citizenship, embracing the demands of the Belizean, Regional and Global communities.
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