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Application Form for Honoris Causa Award

Name: Chicago Open University
Address: 19 Holly Cove LN Dover, Kent Delaware, DE, 19901, US
Telephone: +1(585)-316-1905
Price range: 4500$

Personal Information

Upload Your Photo (Optional)

Full Name(As Per Certificate) *

Date of Birth *

Age *

Mobile Number *

State *

Country *

Zip Code *

Email Address *

Facebook URL (Optional)

Linkedin URL (Optional)

Address *

Mother Tongue *

Marital Status *

Single Married

Father's Name (Optional)

Languages Known (Optional)

Qualification Information

Qualification	Name of School / College	Year of Completion	Subjects (Place "," after Subject)
SSC (10th) *
HSC (12th) *
Graduation *
Post Graduation *
Other (Optional)

Document Checklist

1.Please provide a short autobiographical summary (maximum 3,000 words) highlighting your significant contributions to knowledge enhancement, innovation, standard-setting, and societal welfare within your area(s) of expertise. This summary will support the evaluation of your nomination for the conferment of the Honorary Doctorate (Honoris Causa) award. (Optional)

Words: 0 / 3000

2. Please attach all the following documents in PDF, JPG, PNG format: (Optional)
a). Curriculum Vitae(CV)/Resume

b). Recent Passport-Size Photographs

c). Copies of all relevant Educational Certificates and Supporting documents

d).Recommendation Letters (if applicable)

e).News articles / Media coverage (if any)

f). A Copy of a Valid identification document (Passport, Voter ID , Aadhar ID or any other Government Issued National ID)

3. Work related certificate/ Achievement/ Experience need to upload. (Optional - All files in a Single PDF)

Reference Contacts

Relation 1

Name *

Relation *

Contact Number *

Occupation (Optional)

Relation 2

Name *

Relation *

Contact Number *

Occupation (Optional)

SECTION G: Declaration

I hereby declare that the information provided in this application is true and correct to the best of my knowledge. I understand that submission does not guarantee the conferment of the Honorary Doctorate Award (Honoris Causa) and that the institution reserves the full right to approve or reject the application based on its internal review process. *

I am fully aware that the Honoris Causa is a non-academic, honorary award conferred in recognition of my contributions to society/industry and not an earned academic qualification. I confirm that I will not misuse or misrepresent this honor at any stage or in any context.I am aware that such actions may lead to the revocation of my certificate. *

I also grant full permission to the university to use my name, photograph, biography and any related articles or materials for institutional archives, publications, digital records and promotional purposes. *

Date of Declaration *

Upload Signature (Optional)

Note: It is the responsibility of the person(s) completing this form to provide supporting information on the nomination to enable the Honoris Causa Award Committee to make a decision.

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