FOR OFFICE USE PHOTO 9133/2024/64

Application form
Faculty of Graduate Studies, University of Sri Jayewardenepura
Course Name Master of Arts in Teaching English as a Second Language Code No: 9133

PERSONAL INFORMATION

Full Name Madduma Dewage Rojitha Panasara Krisantha Manm

Name with initial [Link]

39/5
Post Office Road
Address for
Communication Hingurakgoda

51400

Permanent
Address
(if different from previous)

Official Address
(If relevant)

E-Mail Address rojitha6586@[Link]

Profession Self-employed

Home 0717102221
Telephone Office Medium English
Mobile 0717102221

Date of Birth 1194-11-28 NIC No: 943333815V

Civil Status Married Gender Male

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OTHER INFORMATION

Education:
University Period Major Field Degree/Diploma Class-if any Year
University of Jaffna 2017-2021 Medical [Link] (Hons) 2021
Laboratory Degree
Sciences

Note: (i) Attach certified copies of detailed certificates or transcript from your University

(ii) Attach detailed academic record of University career including Scholarships and awards,
diplomas, degrees, publications.

Attach a brief account on your professional experience in relevant disciplines mentioning the duration.
Note: (i) Attach documentary evidence.
Are you already registered as a student at Sri Jayewardenepura University or any other instruction? If so
given details:

Nature of your present employment (if employed):

Self-employed

Do you have the approval of your employer? Yes No

PUBLICATIONS /RESEARCH WORK (if any)

List research topics, and the nature of the research activity undertaken.

PROFFESSIONAL QUALIFICATIONS

Institute Period Field of study/Training Qualification Year

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ANY OTHER QUALIFICATIONS (if any)

BRIEFLY DESCRIBE YOUR REASONS FOR WISHING TO ENROLL IN THE PROGRAM.

(Include your personal/ career interests)

My first degree is in medical laboratory sciences, which is unrelated to teaching English. However, with four
years of experience as a freelance English teacher, I am now eager to deepen my expertise by pursuing a formal
qualification in English teaching and expanding my career opportunities in this field.

ATTACHMENTS

Upload the following documents YES / NO

Color photograph
YES
Scanned copy of Birth certificate
YES
Degree certificate
YES
Bank payment receipt
YES

GIVE NAMES AND CONTACT DETAILS OF REFEREES

1. 2.
Jayanaka Ranaraja Dinuka Gayan

0716480034 0770057587

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SELF ASSESSMENT OF PROFICIENCY IN ENGLISH
Very good Good Fair Weak
Reading
Writing
Conversation

Department of Study
Field of Research

Institute where the research is to be carried out:

DECLARATION OF THE APPLICANT

I have instructed the Registrar of the ………………………………………………………………………………

(University/Institute) to send my Academic transcript directly to the office of the Deputy Registrar, of Graduate
Studies, University of Sri Jayewardenepura.

I certify that all information provided above is correct and I agree to abide by and be subjected to the regulations
of the PGIS if this application is accepted.

…………………………….. ………………………………….
Date Signature of Applicant

OBSERVATIONS OF HEAD OF DEPARTMENT

I certify that the facilities available in my department/institution can be utilized for the project.

Remarks if any:

Date:……………………….. ……………………………..
Head of Department

RECOMMENDATION OF THE BOARD OF STUDY

……………………………………………………………………………………………………………
……………………………………………………………………………………………………………

The Board of Study recommends/does not recommend the issue of the letter of registration after the
payment of prescribed fees by the candidate.

……………………………………
Chairman/Board of study

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 2024-08-16 13:00:07
Application Submitted Date and Time

FOR OFFICIAL USE

RECOMMENDATION OF SENATE

Date of Senate Approval

Meeting No:
Date

DEAN – FACULTY OF GRADUATE STUDIES

Approval for Data Entry

Yes No

Date: ……………………… …………………………………………..

Dean/Faculty of Graduate Studies

DATA ENTRY

Data Entered by:

Name of the Data entered person

Designation
Date of Entry

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  Please return to the FGS website & upload the following documents in pdf format using the
previous application procedure.

1. Color photograph (4cm x 3cm background should be Sky Blue jpg format)
2. Scanned copy of Birth certificate
3. Degree certificate
4. Bank payment receipt (You are requested to pay the application fee of Rs. 2000
for the account number 053010006780 to any branch of People’s Bank.)

 If necessary, you are allowed to edit your details when uploading documents

 For employed applicants the declaration of the employer agreeing to release the applicant for the
study needs to be annexed.

 If there is any difficulty in uploading documents, please send by registered post or hand deliver
the completed application form to the above address on or before the closing date.

Deputy Registrar,
Faculty of Graduate Studies,
University of Sri Jayewardenepura,
Gangodawila,
Nugegoda,
Sri Lanka.
Telephone No: +94 11 2881551

 If you already have supervisor(s) (external / internal) assigned to your research, please include
their approval before sending the documents.

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