Registered Student Information

Student Name:
ID NO:
Country: USA

Student Full Name Photograph

Membership ID

Term Applying

No of Universities Applying

Date of Registration
 Personal Information: (Don’t use <dots> ‘.’ anywhere in the form)

Given Name (As per passport)

Last/Sur Name (As per passport)

Middle Name

Permanent Address
a. House Number & Street Address
b. City & State
c. Zip Code
Please mention mailing address, if
different form permanent address.
Data of Birth (MM/DD/YYYY):
Place of Birth
Contact Numbers (Mobile & Home
Phone) Format: +911234567890
Father’s Name & Phone Number
(Emergency Contact Person)
Grand Father’s Name
Email ID
Email Id Created by Representative
/ Password
Passport Number & Date of Expire
Place of Issue

Native Place

Academic Information:

Bachelor’s
Bachelors Degree
Major / Stream (Full Form)
Percentage/ CGPA &
Backlogs
Course Tenure
(MM/YYYY – MM/YYYY)
College Name
University Name

12th 10th
Major / Stream
Percentage
Course Tenure
(MM/YYYY – MM/YYYY)
College Name & Board
Location

Test Scores Information:

GRE / GMAT Information: Score Percentile

Verbal
Quantitative
Analytical (AWA)
TOTAL

Login ID / Password

Test Date & Time (MM/DD/YYYY)

Registration Confirmation number
TOEFL / IELTS / PTE Information:
User ID/Password (if TOEFL)
Test Date & Time (MM/DD/YYYY) 08/24/2020
Listening Reading Speaking Writing Total:

Recommendation Providers Information:

Name of Professor Email ID Phone Number Designation

Universities Suggested:
S No University Name Major Applied
1

8
 For Office Use Only:
Applications Information

S. Confirmation
University Applied Login ID Password Remarks
No Number
1.
2.

3.

4.

5.

6.

7.

8.

List Confirmed
Date Applications Done by Date
by
Slot 1
Slot 2

Pending Issues (If Any) _____________________________________________

Payment Information
Application GRE Reporting TOEFL Reporting
University Name Date CC/DD
Fee Date Date

GRE Score Reporting Charges $25

TOEFL Score Reporting Charges $18
IELTS Score Reporting Charges Rs. 1250

Courier Information

University Name Courier Date Packet done by Tracking # Status/ Issues

References: