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Application Form

The document is an application form for overseas education consulting. It requests personal details like name, passport information, education history, intended major, and finalized university choices. Recommenders' details are also requested.

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ajithkumar739755
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16 views

Application Form

The document is an application form for overseas education consulting. It requests personal details like name, passport information, education history, intended major, and finalized university choices. Recommenders' details are also requested.

Uploaded by

ajithkumar739755
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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HARITHA OVERSEAS EDUCATION

CONSULTANTS LLP
APPLICATION FORM

FIRST NAME (As per the Passport) : AJITHKUMAR SURNAME (As per the Passport) : ELANGOVAN

PASSPORT NO : V2052894 VALID FROM: 19/07/2021


VALID TO: 18/07/2031

GRE REG NO : TOEFL/IELTS REG NO :


TEST DATE : TEST DATE :
VERBAL : QUANTS : AWA : TOTAL : L: S: R: W: O:
ESTIMATED DATE (If not taken) : ESTIMATED DATE (If not taken) :
ESTIMATED SCORE : ESTIMATED SCORE :

10TH - 12TH -
PERCENTAGE : 79% PERCENTAGE : 83%
SCHOOL : ANNAI TERESA MATRICULATION SCHOOL : FATIMA MATRIC & HIGH SEC SCHOOL
SCHOOL FROM : 2020 TO : 2021
FROM : 2018 TO : 2019
UG – PG –
PERCENTAGE/CGPA : PERCENTAGE/CGPA :
COLLEGE/UNIVERSITY : COLLEGE/UNIVERSITY :
UG MAJOR : PG MAJOR :
FROM : TO : FROM : TO :

WORK EXPERIENCE : D.O.B (As per the passport - 03/06/2003)


COMPANY NAME : PLACE OF BIRTH : JAYANKONDAM
DESIGNATION : MOBILE : 7305438726
FROM : EMAIL ID : [email protected]
TO :

ADDRESS : FATHER’S FIRST NAME : Elangovan


FATHER’S LAST NAME : Chandrahasan
STREET-1: 6/2, North street, Anaikudam MOBILE : 7094866245
STREET-2 : Ariyalur (dt), 612902 EMAIL : [email protected]
CITY : Jayankondam
STATE : Tamil Nadu MOTHER’S FIRST NAME : Anjalai
COUNTRY : India MOTHER’S LAST NAME : Elangovan
PINCODE : 612902 MOBILE : 6369797260
EMAIL : [email protected]
INTENDED MAJOR : BS Computer Science SPECIALIZATION (If Any) :

RECOMMENDERS DETAILS : FINALIZED UNIVERSITIES WITH COURSE :


REFEREE 1 :
NAME – 1. ARIZONA STATE UNIVERSITY B.S. in Computer
DESIGNATION – Science
EMAIL – 2. University of North Texas B.S. in Computer
MOBILE – Science
ADDRESS – 3. University of Albany, The State University of
New York, Albany (SUNY Albany)
REFEREE 2 : B.S. in Computer Science
NAME – 4. Washington State University
DESIGNATION – B.S. in Computer Science
EMAIL – 5. New York Institute of Technology
MOBILE – B.S. in Computer Science
ADDRESS –
6.
REFEREE 3 :
NAME – 7.
DESIGNATION –
EMAIL – 8.
MOBILE –
ADDRESS – 9.

10.

NOTE : Please make sure that all the information you are providing in the form are accurate
as per your Passport and educational documents.

I hereby confirm that all the information provided in this form is checked and finalized by me.

Regards,

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