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APPLICATION FORM
1. Course Information
Course Name:
Clinical Sciences (USA)
Month and Year of Entry:
July 2025
2. Personal Information
Full Name:
Gender:
Date of Birth:
Nationality:
New Applicant Test 1
Female
7 February 2022
Bangladesh
Passport Number:
B9876543210
Passport Issued Country:
Bangladesh
Passport Expiry Date:
15 February 2026
Correspondence Address:
Test correspondence address
Banglamotors, Dhaka 1205, Bangladesh
Permanent Address:
Test permanent address
Banglamotors, Dhaka 1205, Bangladesh
3. Contact Information
919985973119
4. Academic Information
Institution
Institution1
Subject
Subject1
Level
Level1
Grade
Grade1
Achieved
Achieved1
Date of completion
01/01/2021
Institution2
Subject2
Level2
Grade2
Achieved2
01/02/2021
Institution3
Subject3
Level3
Grade3
Achieved3
01/03/2021
Institution4
Subject4
Level4
Grade4
Achieved4
01/04/2021
Institution5
Subject5
Level5
Grade5
Achieved5
01/05/2021
5. Entrance Exam Results
Name of the Exam:
Entrance exam name
Score/ Grade:
Entrance exam grade
Exam Date:
10 January 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
Advanced
Yes
(If Yes, please provide details)
Title:
Language Title1
Language Title2
Language Title3
Grade:
Language Grade1
Language Grade2
Language Grade3
Verification ID:
Language Verification Id1
Language Verification Id2
Language Verification Id3
Date of completion:
01/01/2022
01/02/2022
01/03/2022
7. Personal Statement/ Motivation
Test Personal Statement - Our program in Premedical Sciences is tailored to equip students with the necessary skills and knowledge excel in our Doctor of Medicine Program, which encompasses both Basic Sciences and Clinical Sciences. Enroll with us today and embark on a fulfilling journey towards a career in medicine. 2Our program in Premedical Sciences is tailored to equip students with the necessary skills and knowledge excel in our Doctor of Medicine (MD) Program, which encompasses both Basic.
8. Employment
Please provide details of Current and Previous work experience (if applicable).
Organization:
Employment Org1
Employment Org2
Employment Org3
Position Held:
Position held1
Position held2
Position held3
From Date:
01/01/2018
01/01/2019
01/01/2020
To Date:
31/12/2018
31/12/2019
31/12/2020
9. Criminal Offense
Have you ever been convicted of a criminal offense?
(If Yes, please provide details:)
No
Offense not applicable
10. Financial Information
How do you plan to finance your studies abroad?
Self-funded
Financial not applicable
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
Additional not applicable
No
Disability not applicable
12. Required Documents
List of attached documents:
Copy of your passport or national ID, Academic transcripts and certificates, Letters of recommendation (minimum of 2), Proof of English proficiency (if applicable), Medical Fitness Certificate, Police Clearance Certificate, Resume/CV
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.