CIU Admission Form

Chittagong Independent University

12, Jamal Khan Road, Chittagong-4000

Phone: 02333352926, 02333351262, 01946-973778, 01844216660

Application Form for Admission

Full Name:*		Gender:*
Mobile No.:*		E-mail:*
Current Address:*		School/Department:*
Program Type:*		Program Name:*
Applied Semester:*		Applied Year:*
Do you want to transfer credit in?:*

Fathers Name:*		Mothers Name:*
Date of Birth:*		Blood Group:*
Nationality:*		NID/Birth Certificate No.:*
Religion:*		Intended major:*

Medium of Instruction:*	Bangla Medium	English Medium

SSC Information
Name of institution:*		Group:*
Board:*		Passing Year:*
GPA/Division:*

HSC Information
Name of institution:*		Group:*
Board:*		Passing Year:*
GPA/Division:*

O Level Information
Name of institution:*		Passing year:*
Subjects:*		Grades:*

A Level Information
Name of institution:*		Passing year:*
Subjects:*		Grades:*

Undergraduate Information
Name of institution:*		Passing year:*
Undergraduate Student ID:		Undergraduate Degree Name:*
Undergraduate CGPA/Division:*		Undergraduate Major Name:*
Undergraduate Minor Name:

Other Degree Information (if any)
Name of institution:		Passing year:
Other Degree Student ID:		Other Degree Name:
Other Degree CGPA/Division:		Other Degree Major Name:
Other Degree Minor Name:		Admission Form Fee:*

Attachments (.jpg, .jpeg, .png, .pdf)
SSC Transcript:*		SSC Certificate:
HSC Transcript:*		HSC Certificate:
O Level Transcript:*		O Level Certificate:
A Level Transcript:*		A Level Certificate:
Undergraduate Transcript:*		Undergraduate Certificate:
Other Degree Transcript:		Other Degree Certificate:
A recent passport size photograph:*

	By ticking here I am ensuring that, all information I have submitted here are real and I agree to the Terms & Conditions, Refund Policy, Privacy Policy and Admission Eligibility
	I do hereby declare that all the information given above is true to the best of my knowledge and belief. I accept that CIU reserves the right to restrict my admission or cancel my registration at any time if any of the information given by me on this form is found to be false or incorrect.

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