UNIVERSITY OF CAPE COAST

CENTRE FOR INTERNATIONAL EDUCATION

STUDY ABROAD STUDENT APPLICATION
(August 2018)

Please complete this form in its entirety using BLOCK letters. Completed applications should be sent to the Centre for International
Education (CIE) at the University of Cape Coast (UCC). All applications must include the following to be considered complete:

1. Official transcript(s) from the home university and any other previously attended tertiary institutions.
2. A statement of interest.
3. A current CV or résumé, and the bio-data page of passport.
4. Proof of Financial support.
5. A letter of support from your home institution.
6. Six (6) recent physical passport-size photographs (Two of which will be required by the Ghana Immigration Service for
extension of permit while in Ghana). Your name should be written on the back of each photograph.
7. Application fee of $100.00 USD (students from Affiliate Partner Institutions are exempted from paying this fee)
8. Students from non-partner institutions would pay the required tuition fee.

BIOGRAPHICAL INFORMATION

Family Name: DABO Given Name: MAIMOUNA

Other Names: Sex: Male □ Female □X

Nationality: SENEGALESE Date of Birth: (d/m/yr) 18 /01/2000

Place of Birth: DAKAR

CONTACT INFORMATION
PERMANENT ADDRESS

Address: NEW CITY DE CAMBERENE N° 641- DAKAR

Phone: 00221 77 445 32 04 Fax: Email: dabo.maimouna20@gmail.com

HOME INSTITUTION CONTACT PERSON AND ADDRESS

Name: BORDEAUX SCHOOL MANAGEMENT (BEM)

Address: Sacré Coeur 3 Pyrotechnique, Dakar 25208

Tel: (+221) 33 869 82 81 / (+221) 77 704 77 77 Fax: Email: contact@bem.sn

FOR OFFICIAL USE ONLY

Application Fee: Application Vetted By:

Receipt No.: Date: (d/m/yr) ________________________________________

ID No.: Signature:………………………………………………………………………….

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EDUCATION
Attendance Dates Particulars of Offices held and/or
Name of School/College & Location
From (m/yr) To (m/yr) other activities at school
BORDEAUX SCHOOL MANAGEMENT (BEM) License1
DAKAR October 2019- August 2020 STUDENT
BORDEAUX SCHOOL MANAGEMENT (BEM) License 2
DAKAR October 2020- August 2021 STUDENT

LEVEL OF STUDY

First Year □ Second Year □X Third Year □ Final Year □ Graduate Student □

LENGTH OF STUDY AT THE UNIVERSITY OF CAPE COAST

One Semester □ X Two Semesters □

EMPLOYMENT HISTORY
List Particulars of Past and Present Employment and Dates:

Institution/Organization Position Held Dates

Nothing to report

COURSE SELECTION
Please indicate your course selection preferences.
First Choice Alternative Selection (If First Choice is not Available)
COURSE CODE COURSE TITLE COURSE CODE COURSE TITLE
AGP 201 AEN 408N Agricultural Waste Management and By-Product
Introduction to Food and Nutrition Utilization
AGP 202 AGP 402 Agricultural Produce Processing III
Food Microbiology
AGP 203 AGP 403 Agricultural Produce Processing III Practicals
Food Microbiology Practical
AGP 204 Food Biochemistry AGP 404 Entrepreneurship and Business Development
AGP 205 AGP 405 Management of Agro-based Industries
Food Biochemistry Practical
AGP 206 AGP 406 Project Planning and Evaluation
Principles of Post-Harvest Technology
AGP 207 Principles of Food Hygiene AGP 407 Food Quality and Safety Standards

AGP 208 Value Chain Approach in Agriculture

FINANCIAL INFORMATION
Please indicate how you plan to finance your study at the University of Cape Coast.

□Self □Government Aid □XFamily Assistance

□Other…………………………...
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EMERGENCY CONTACT PERSON(S)

Name: MMe DABO AMINATA TANDIAN Address: NEW CITY DE CAMBERENE N° 641- DAKAR

Home Phone: (00221) 77 644 52 14 Work Phone: (00221)338649831 Mobile: (00221) 77 644 46 51

Email: ami_tandian@yahoo.fr/ mamadoudabo2003@yahoo.fr/ adabo@agetip.sn Other information: ………………………….

APPLICATION INFORMATION Have you ever applied for admission to the University of Cape Coast before? Yes □ No □X
If Yes, when did you apply? (d/m/yr)

What were your reasons for not attending at that time?

IMPORTANT: AN APPLICANT WHO MAKES A FALSE STATEMENT OR WITHHOLDS RELEVANT INFORMATION MAY BE
REFUSED ADMISSION. IF HE/SHE HAS ALREADY COME INTO THE UNIVERSITY, HE/SHE MAY BE ASKED TO WITHDRAW.

Signature: Date: (d/m/yr:) 11/08/2021

DECLARATION

This declaration should be signed by someone of high repute who should also endorse one of the passport-sized photographs on the
reverse side. The person should be an official representative from your home institution. The application will not be valid if this
declaration is not signed.

I certify that the photograph endorsed by me is the true likeness of the applicant.

Mr./Miss/Mrs. who is personally

known to me. I have inspected his/her certificates and I am satisfied that the names on them conform to those by which, to the best
of my knowledge, he/she is officially known.

Name:

Position: Address:

Signature: Date: (d/m/yr)

Note: All documents submitted in connection with this application become the property of this University.