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UKRAINE EDUCATION ADVISORY SERVICE-UKRAINEEAS

ADMISSION APPLICATION FORM


2016
OFFER FOR 3ARD STUDENT OF 2 HURRY UP

PERSONAL DATA
Date of
Last Name First Sex
birth

Nationality Marital Status

Mother Tongue

Phone E-mail Address

Passport Number Date of Issue Date of Expiry

Place of Issue

Father / Guardian’s Contact Details :

Name and Surname

Address

Phone E-mail Address


English Language Proficiency Level : Medium Of Study :  English  Russian  Ukrainian

Written Spoken

Required Services :
NO
Student Visa YES NO Airport pick-up YES

Invitation Letter YES NO

Accommodation YES NO

ACADEMIC PARTICULARS
School Leaving Certificate :
School/College Address
Attended

Name of the University / Board Year of


Attended passing

Examination Passed - Higher Secondary / Equivalent exam :

School/College

Year of
Address
passing

Please indicate the required courses that you have completed (only for medical & engineering STUDENTS )
Credits Grade

Chemistry

Biology

Mathematics*

Physics*
*Required for SCIENCE STUDENT

Have you ever been dismissed from a college or placed on academic probation? YES NO

If so, please explain:

Any Higher Examination : FOR MASTER & PGD OR PHD STUDENT

 Master’s
Program of Study
Ph.D.

Name of the Address


University/College OR
SCHOOL
Year of
Name of the Course/Degree
passing

INDICATE COURSE YOU WANT TO STUDY :. _____________________________________________________

Score
Applicant’s Declaration:
I certify that the information given in this application is correct and complete.
If I am admitted to a University I undertake to observe the University regulations and to ensure Agency payments and tuition fees with
other financial liabilities to the University.
Applicant's Signature: ___________________________ Date: ____________________

OFFICE USE ONLY


Applicant's Signature: ___________________________ Date: ____________________

We hereby acknowledge receipt of the candidate’s application. The above-mentioned student is:

􀀀 provisionally accepted at our institutions


􀀀 not accepted at our institutions
UKRAINEDUCATION: Branch Coordinator’s Signature: ................................................
Date: ....................................

UKRAINEDUCATION: Headquarters Admission Officer’s Signature: .........................................

Date: ...........................

...................................................
Stamp