Permanent Address:
Address for Communication, if different from above:
With the completed application, I am enclosing the following required document (for initial processing) with my application
1 ) A detailed curriculum vitae or bio data;
2 ) Passport sized photo with name and signature on back;

Research and Publications (use separate paper if necessary)

I certify that I voluntarily enrol and willingly support the concept of Continuing Education Programs. . I understand that no action will be taken on my application without submitting all the required credentials. I authorize full investigation of my application. Clicking the SUBMIT button, is the authorization to anyone to release any information you may request on me. I agree to indemnify, release and hold harmlessNU and its Agents from any liabilities or torts by reason of their acts or omissions in connection with this application. I agree to abide by the decision of NU or its agents. I agree to function within the limits of my competency and I guarantee and warrant that NU (and its agents) assume no responsibility for any of my activities or actions.
It is understood by me that any falsification of records, misrepresentation of material facts, dishonesty, forgery, and unethical practices will automatically render any certifications awarded to me NULL and Void. Under penalty of perjury, I guarantee and warrant that all information provided on all pages of this application are true and correct. I am legally bound by the foregoing as attested to here with my signature below.
I have read and understood the disclaimer provided.
NU admits professionals to its organizations of any race, color, national origin, sex, age, handicap, or religious preference in its education programs, activities, and employment as required by the Civil Rights Act of 1964 and amendments including Title IX of the Educational Amendments of 1972.