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APPLICATION FORM
1. Course Information
Course Name:
Preclinical Sciences (Antigua)
Month and Year of Entry:
May 2025
2. Personal Information
Full Name:
Gender:
Date of Birth:
Nationality:
Shekhar Chandra
Male
12 February 2024
United States
Passport Number:
A9876543210
Passport Issued Country:
United States
Passport Expiry Date:
15 March 2025
Correspondence Address:
Test corres street
Madambakkam, Chennai, Tamil Nadu, India
Permanent Address:
Test permanent street
Madambakkam, Chennai, Tamil Nadu, India
3. Contact Information
918309171140
4. Academic Information
Institution
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Subject
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Level
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Grade
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Achieved
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Date of completion
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5. Entrance Exam Results
Name of the Exam:
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Score/ Grade:
Test
Exam Date:
4 February 2025
6. Language Proficiency
Is English your first language?
If no, please specify your proficiency in English:
Have you taken any English proficiency tests? (e.g., TOEFL, IELTS)
Yes
Intermediate
Yes
(If Yes, please provide details)
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Grade:
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Verification ID:
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Date of completion:
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7. Personal Statement/ Motivation
Please complete ALL sections of this form CLEARLY and ACCURATELY. If information is missing, we will not be able to process your application. Please complete ALL sections of this form CLEARLY and ACCURATELY. If information is missing, we will not be able to process your application. Please complete ALL sections of this form CLEARLY and ACCURATELY. If information is missing, we will not be able to process your application. Please complete ALL sections of this form CLEARLY and ACCURATELY. Testing.
8. Employment
Please provide details of Current and Previous work experience (if applicable).
Organization:
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Position Held:
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From Date:
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To Date:
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9. Criminal Offense
Have you ever been convicted of a criminal offense?
(If Yes, please provide details:)
Yes
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10. Financial Information
How do you plan to finance your studies abroad?
Sponsorship
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11. Additional Information
How did you hear about this program?
(Additional comments in the next box)
Do you have any disabilities or special needs that we should be aware of?
(If Yes, please provide details:)
Internet Search
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Yes
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12. Required Documents
List of attached documents:
Copy of your passport or national ID, Letters of recommendation (minimum of 2), Proof of English proficiency (if applicable)
Declaration
I hereby declare that the information provided in this application is accurate and complete to the best of my knowledge. I understand that providing false information may result in the rejection of my application.