THE IMPERIAL COLLEGE

C Block, Izmir Society, Canal Bank Road
Lahore- 53800
Punjab, Pakistan
Tel: 92 42 37499301-6 Fax: 92 42 37499085
Email: chutiyo.Sitishacked@from2months.contactanyadministrator

Application For Admission

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Program Applied For

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Personal Information

Surname/Family Name:*

Other Names: (in full)

National I.D. Card No.*

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Name of Father/Guardian:*

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Permanent Home Address:*

Home Telephone No.:*

Daytime Telephone No.:

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Student's Email Address:

Parent's Email Address:

Correspondence Address:*

Admission Tests

SAT

Date taken:

Test score:

Attach documentary evidence:

GMAT

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Test score:

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IELTS/TOEFL

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Test score:

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Academic Background/Qualifications

No.1

Institution Name:*

Dates Attended:(From-To)

Main subject (s) or Area (s):

Date of Award:

Degree/Award Received:*

Division/Grade:*

No.2

Institution Name:*

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Main subject (s) or Area (s):

Date of Award:

Degree/Award Received:*

Division/Grade:*

No.3

Institution Name:

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Date of Award:

Degree/Award Received:

Division/Grade:

No.4

Institution Name:

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Main subject (s) or Area (s):

Date of Award:

Degree/Award Received:

Division/Grade:

No.5

Institution Name:

Dates Attended:(From-To)

Main subject (s) or Area (s):

Date of Award:

Degree/Award Received:

Division/Grade:

No.6

Institution Name:

Dates Attended:(From-To)

Main subject (s) or Area (s):

Date of Award:

Degree/Award Received:

Division/Grade:

Attach documentary evidence of degrees mentioned above: (Single file i.e. rar or image File)

Professional and Other Qualifications

No.1

Institution Name:

Dates Attended:(From-To)

Subject(s) in which Award Obtained:

Qualification Obtained:

No.2

Institution Name:

Dates Attended:(From-To)

Subject(s) in which Award Obtained:

Qualification Obtained:

No.3

Institution Name:

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Subject(s) in which Award Obtained:

Qualification Obtained:

Attach documentary evidence of qualifications mentioned above: (Single file i.e. rar or image File)

Reference (Give Full names and Addresses of Two Referees; Atleast One must be Academic referee)

No.1

Name:*

Position held:

Employer:

Telephone No.:*

Address:

No.2

Name:*

Position held:

Employer:

Telephone No.:*

Address:

Employment And Experience

No.1

Name of Employer:

Address of Employer:

Dates of Employment: (From-To)

Position held:

Primary Responsibilities:

No.2

Name of Employer:

Address of Employer:

Dates of Employment: (From-To)

Position held:

Primary Responsibilities:

No.3

Name of Employer:

Address of Employer:

Dates of Employment: (From-To)

Position held:

Primary Responsibilities:

Interests And Hobbies

Other Information*

Please use this section to tell us why you wish to study for this degree at The Imperial College? What are your career interests and how would this degree help you achieve your objectives?

Other Applications

Are you applying to other Institutions? If yes, please list their names In order of your preference.

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Source Of Program Information

Please give brief details of how did you hear about the Imperial College degree program.

financing

How do you plan to finance your studies at the Imperial College? Please check the appropriate boxes.

Personal funds

College financial aid

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Declaration

I certify that the information given in this application is correct and complete. If any time, it is found that in formation given in this application form or submitted in support of it is materially incorect or inaccurate, I may be dropped from the College. If admitted, i also undertake to observe the College rules and regulations and will ensure the payment of all dues and fees on time.

I Agree

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