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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:
Test Name
Male
1 February 2024
Antigua and Barbuda
Passport Number:
B987654321
Passport Issued Country:
Antigua and Barbuda
Passport Expiry Date:
8 February 2026
Correspondence Address:
Test street name correspondence
Antigua and Barbuda
Permanent Address:
Test street name permanent
Antigua and Barbuda
3. Contact Information
919985973119
4. Academic Information
Institution
Test
Subject
Test
Level
Test
Grade
Test
Achieved
Test
Date of completion
Test
5. Entrance Exam Results
Name of the Exam:
Test Exam
Score/ Grade:
Test Score
Exam Date:
12 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
Advanced
Yes
(If Yes, please provide details)
Title:
Test
Test
Grade:
Test
Test
Verification ID:
Test
Test
Date of completion:
Test
Test
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:
Test
Position Held:
Test
From Date:
Test
To Date:
Test
9. Criminal Offense
Have you ever been convicted of a criminal offense?
(If Yes, please provide details:)
No
10. Financial Information
How do you plan to finance your studies abroad?
Sponsorship
Test
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:)
Other
Test
Yes
Test
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.