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					                                              Application Form




         Emails: star_consultants_ukraine@yahoo.com, star.educonsult@gmail.com, info@edu-ukraine.com

                      Website: www.edu-ukraine.com, Tel: +380 67 8963521, +380 937576143
Name and contact information                  ↓PERSONAL DETAILS ↓
NAME: ↓Your legal name ↓Fill APPLICATION form in CAPITAL words i.e. clear, visible, understandable


        Family (last) name ↑                          First name ↑                                   Middle name ↑
                                                                                                  -             -
 Place of birth↑                Nationality by birth↑       Male         Female         Day                 Month                  Year
                                                                 Sex ↑                               Date of birth ↑


  Current Nationality↑          Int’l Passport No.↑        Passport Issue & Expiry Date↑          Place of issue of Ukraine visa↑

Program you                                                        I do not have Int’l passport, since I do want to secure my
                                                                   admission & I’ll forward the Int’l Pass. later once its ready      
want to join →
                               Higher Secondary School Cert.Bachelor                        Specialist
Current Qualification →
                               Master                      Ph.D.                           Other ________________
                                                               Degree                          BachelorSpecialist
University in Ukraine
                                                               sought                          Master Ph.D.
you prefer to join →
                                                                 →
↓VALID POSTAL ADDRESS & CONTACT NUMBERS(Invitation letter will be forwarded later to this address) ↓


            Street number and street name ↑                                              City/Suburb ↑

         Province or State ↑               Zip or Postal Code & Country ↑                           Email address↑
Tel. No.:→
Fax     →
                   Country Code ↑                 Area Code ↑                                   Local number ↑


Applicant's Signature: →                                                                   Date: →


I justify that information given above is complete and accurate.                               ___________
                                                                                              Applicant's Signature
Scan Application form with following documents
→All available Educational Certificates/ Diplomas/ Transcripts (O level/Senior School Certificate Examination/ Higher
Secondary School Certificate Examination/ Bachelor/ Master Degree if available)

→International Passport scans (Data page with Photograph, Name and Serial number)                                         Your
              Forward all scans to: star_consultants_ukraine@yahoo.com, star.educonsult@gmail.com,                        current
                                                info@edu-ukraine.com
                                                                                                                          Picture

				
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posted:6/18/2012
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