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					                                                     The Aga Khan University
   S                                                      Medical College                                                           Attested 7 days old
 BB                                                 Application for Admission - I
                                                                                                                                 passport size photograph
M                                                                                                                                bearing the name of the
     11                                                                                                                           applicant at the back.
   20                                                                                                                              (Please do not attest
                                                                                                                                   on candidates face)

                                                                                                                                        Please staple
 PLEASE WRITE IN CLEAR HANDWRITING OR TYPE
 Please note that incomplete and incorrect information will disqualify the candidate
 from the admission process.
 (Please use Block letters)
                                                                                                                                  (Please leave blank).
 A.       Personal Data

 Name:                                                              Father’s Name:

 Date of Birth:______________                  ______________                __________________                __________              ____________
              Day/Month/Year                     Place of Birth              Country of Citizenship            Male/Female             Single/Married

 Correspondence/Contact Address:
 Please do not use short forms. Candidates resident overseas are required to state addresses where they can be contacted
 in person. This address should be noted on the self addressed envelope.
 _________________________________________________________________________________________________
 _______________________________________________________________________ City: _________________

 Post Code: __________________ Telephone #:_____________________                                    Fax #:____________________

 E-mail Address:_____________________________________ Mobile #: ___________________________

 Permanent Address (if different from correspondence address above)
 _________________________________________________________________________________________________
 _______________________________________________________________________ City: _________________

 Post Code: __________________ Telephone #:_____________________                                    Mobile #:____________________

 B.       AKU Medical College Admission Test
 Circle only one Centre for the Admission Test and yo ur preference of Interview Centre, if shortlisted.

 For Applicants writing AKU Admission Test in Pakistan
 AKU Admission Test                                                                             Interviews (if shortlisted)
  Hyderabad   Karachi   Lahore    Multan   Quetta    Rawalpindi     Gilgit   Chitral                Karachi    Lahore     Rawalpindi


 For Applicants writing AKU Admission Test Overseas
 AKU Admission Test                                                                             Interviews (if shortlisted)
  Dubai       Houston    London      Nairobi     New York    Singapore       Toronto                Toronto    London     New York       Houston




 C.       Did you apply to AKU previously:                            Yes                 No

 If yes: Year of previous application(s) ________________ Application Number(s):___________

 Official: Please do not write in this space:


 Complete         Repeat          Provisional          Incomplete                       Pakistani        OHS         BRT         AMR            OTH

 Application received through:                  Mail              Counter

 Documents awaited:

 Date: ________________                    Received by__________________                                      Fee:      Local           Foreign

 Mode of Payment:                  Cash                     Draft                      Online Payment
D.       Academic Qualifications Please complete the sections and enclose the mark sheets where applicable.
Pakistani System of education

                                        Secondary School Certificate (SSC)
Name of Institution: _______________________________Board of Education: _______________________
City and Country of Study: _______________________ SSC year of completion: ___________

      Academic Qualification                     Marks / Division /Grade                      Year of Completion

SSC


                                  Higher Secondary School Certificate (HSC)
Name of Institution: _______________________________Board of Education: _______________________
City and Country of Study: _______________________________________________________________
Status of Programme:         Enrolled         Completed              HSC year of Completion: __________________


      Academic Qualification                    Marks / Division / Grade                      Year of Completion

HSC I
HSC II


British System of Education

                                             Ordinary Level (O-Level)
Name of Institution: ______________________________________________________________________
City and Country of Study: ____________________ Year in which you completed O-Level: ___________


          O-Level Subject                         Grade and Percentage                        Year of Completion

Biology
Chemistry
Physics
English Language




                                             Advance Level (A-Level)*
Name of Institution: ______________________________________________________________________
City and Country of Study: _______________________________________________________________
Status of Programme:         Enrolled         Completed                    Graduation Year: __________________


          A-Level Subject                        Grade and Percentage                        Year of Completion

Biology
Chemistry
Physics / Mathematics
*Note: An equivalance certificate/ eligibility certificate (as applicable) will be required to complete your application.
 Other Systems of Education (Please complete as applicable)*



                     Undergraduate*                                                       Graduate*

            American System                                               Bachelors in Science (BSc)
                                                                          Masters in Science (MSc)
         Canadian System
                                                                         If other please specify: ___________________
         Others
                                                                  Majors:
                 International Baccalaureate [IB]                 __________________________________________
                HSc from Other Countries
                                                                  __________________________________________
                If other please specify: _____________
                                                                  __________________________________________



  Name of Institution: ______________________________________________________________________
  City and Country of Study: _______________________________________________________________
  Status of Programme:         Enrolled         Completed                    Graduation Year: __________________
  Cumulative GPA/ Grade / Percentage: _______________________________


                  Subjects                        Grade/ Marks/ Percentage                     Year of Completion

  Biology
  Chemistry
  Physics
  Mathematics
  Others:




*Note: An equivalance certificate/ eligibility certificate (as applicable) will be required to complete your application.
E.   For Applicants following American and Canadian system of education:
     (Please see brochure for eligibility and deadlines for completing requirements)

     If shortlisted: SAT II / AP is required to complete your application.

              Please specify: Are you opting for SAT II or AP :        SAT II          AP
              If available and valid, please complete the section below:
                                          Scores                     Month & Year
              Biology                     _________                  ___________
              Chemistry                   _________                  ___________
              Physics                     _________                  ___________
              Mathematics                 _________                 ___________

              For awaited results please specify the date of the test you will be writing: _____________________

     Please note: Minimum scores meet eligibility requirements only and may not be competitive for final selection.
     (Please attach score sheet with the application if available)

     F.       Is PMDC Eligibility Certificate applicable for you:            Yes            No

     G.      Are you applying for any other programme in the Aga Khan University:                Yes           No

             If Yes, please specify: ________________________________________


     Please Note:
     Aga Khan University reserves the right to revoke admission and registration if an application form is
     discovered to be inaccurate or incomplete, or if supporting documents are discovered to be
     fraudulent. Any applicant who presents a fraudulent document in support of an application for
     admission may be identified to other universities and colleges.

     Declaration:
     .



     The statements I have made in my application are true. I understand the implications
     of not providing the equivalance / eligiblity certificate if provisionally selected. I
     agree to conform to the discipline of the selection process and to accept the decision of
     Aga Khan University concerning the evaluation of my application and the final
     selection.


     Date:________ Applicant signature: _______________ Parent /Guardian signature:_____________