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All’Ambasciata d’Italia di Dhaka

PERSPECTIVE STUDENT INFORMATION SHEET

Details of the Italian University where you wish be enrolled

Name of the University


___________________________________________________

Name of the course


_______________________________________________________

Language of the course


___________________________________________________

Applicant’s data

Name ___________________________________________________

Family name_______________________________________________
Sex_________

Date and place of birth


___________________________________________________

Address
________________________________________________________________

Phone number
__________________________________________________________

Email address (in capital


letters)___________________________________________

Are you using an agent for your enrollment procedure?


Yes [ ] Name and contact number of your agent
___________________________
No [ ]

Highest Bangladeshi study degree/qualification (HSC, BSc, MSc, PhD…)

_____________________________________________________________________
___

Issuing School/College/University
__________________________________________

Final score and year __________________

IELTS SCORE_______________________released on_____________________

Can you speak Italian? ___________________________


I declare that the information I gave above is true and I am aware that all
contacts from the embassy will be through my email address and that no change
will be allowed after submitting this form.

Date _________________ Signature

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