ENROLLMENT FORM FOR HIGHER STUDIES APPLICATION
TO BE FILLED BY THE STUDENT (In Block Letters)
NOTE: The details furnished by you will be taken as the base for filling application so please provide the
correct information.
PERSONAL & CONTACT INFORMATION
Surname:
Given Name:
Date of Birth :
Place of birth :
Address:
Mobile: Alternate contact :
Email ID:
Qualification :
Gender:
Marital Status:
Mother Tongue:
Abroad Education Counsel
No. 19, MOBAS Tower, 1st Floor Bull Temple Road (Above Pizza Hut) Near Ramakrishna Ashram Circle
Basavanagudi Bangalore - 560004
Fixed Line +918041281672 Web: www.abroadeducounsel.com
FAMILY DETAILS
Father’s Name
Occupation
Mother’s Name
Occupation
PROGRAM SELECTION
SELECT THE PREFERED COUNTRY
GERMANY SWEDEN NETHERLANDS UK AUSTRALIA
USA CANADA SINGAPORE FRANCE FINLAND
NEWZELAND SWITZERLAND NORWAY ITALY IRELAND
Course
Country (BSc / MSc / MBA)
Intended Specialization applying
for
Date of Enrollment
Intake applying for
Abroad Education Counsel
No. 19, MOBAS Tower, 1st Floor Bull Temple Road (Above Pizza Hut) Near Ramakrishna Ashram Circle
Basavanagudi Bangalore - 560004
Fixed Line +918041281672 Web: www.abroadeducounsel.com
STUDENT’S EDUCATIONAL BACKGROUND
Secondary School
Percentage : Year of passing :
School :
Place :
From (mm/yyyy) : To (mm/yyyy) :
Intermediate
Specialization : Percentage : Year of passing :
College / University :
Place :
From (mm/yyyy) : To (mm/yyyy) :
Graduation
Specialization : Percentage : Year of passing :
College / University :
Place :
From (mm/yyyy) : To (mm/yyyy):
Post Graduation
Specialization : Percentage : Year of passing
College / University :
Place :
From (mm/yyyy) : To (mm/yyyy) :
Abroad Education Counsel
No. 19, MOBAS Tower, 1st Floor Bull Temple Road (Above Pizza Hut) Near Ramakrishna Ashram Circle
Basavanagudi Bangalore - 560004
Fixed Line +918041281672 Web: www.abroadeducounsel.com
TEST SCORES
Test Date Scores Test Date Scores
(DD/MM/YY) (DD/MM/YY)
TOEFL IELTS
GMAT SAT
GRE
EXPERIENCE DETAILS
Sl. No Company Name Designation From - To(mm/yyyy)
PASSPORT DETAILS
Passport No
Place of Issue
Date of Issue
Abroad Education Counsel
No. 19, MOBAS Tower, 1st Floor Bull Temple Road (Above Pizza Hut) Near Ramakrishna Ashram Circle
Basavanagudi Bangalore - 560004
Fixed Line +918041281672 Web: www.abroadeducounsel.com
UNDERTAKING BY THE STUDENT
I _ D/O agree to terms & conditions laid down by
Abroad Education Counsel & Immigration Services is securing admissions in Universities
Abroad.
Further, I solemnly swear and sincerely state that
1. I will be responsible for authenticity or otherwise of the statements or documents
furnished or to be furnished by me.
2. I am responsible for the financial declaration forms and statements that are submitted
for admission / I 20 processes.
3. I am aware and confirm that my contact and e-mail address is created by you and
updated in records.
4. I declare that the information that has been provided in the above quoted application
form is complete and accurate to the best of my knowledge. Signing and submission of
this application permits the counselor or university to request/confirm any further
information necessary to support my application. I am aware that falsifying any
document or information will result in the cancellation of admission at the university.
5. I understand the submission of this application does not in any way guarantee
admission & Visa . My admission & Visa is subject to the application meeting the
university prerequisites and the final decision is at the sole discretion of the university
& Consulate officials only.
Collection of Information: The information on this form and all required admission documentation is
collected for the purpose of determining admission and funding availability. It is collected under the
authority of the College and Institute Act and your privacy is protected under the Freedom of Information
and Privacy Act limiting how your information may be used or disclosed.
Declaration: I declare that the information that I have provided in this application is complete and
accurate. Completion of this signed application permits the counselor/university to request and or
confirm any information necessary to support my application for admission. Falsifying any document or
information will result in the cancellation of admission at the university.
I understand the submission of this application in no way guarantees admission into a program and that
admission is subject to meeting the program, course and university prerequisites and space availability. If I
am accepted into the university Program, I agree to familiarize myself with and to abide by the most
current polices of the College during my tenure as a student.
Abroad Education Counsel
No. 19, MOBAS Tower, 1st Floor Bull Temple Road (Above Pizza Hut) Near Ramakrishna Ashram Circle
Basavanagudi Bangalore - 560004
Fixed Line +918041281672 Web: www.abroadeducounsel.com
REFUND POLICY
I understand that once I have registered for admissions consulting and signed this Agreement, I am not
entitled to a refund of any of the Admissions Consulting fees paid to Abroad Education Counsel.
Withdrawal of registration is permitted within 30days from the date of registration; however there will be
a penalty of 50% of total registration fee as a cancellation fee, post which the registration fee and any fee
paid towards processing stays nonrefundable and non transferrable in case of partial payments.
The registration fees paid holds good for one year from the agreed Intake, The validity expires post one
year of agreed intake and must proceed with a new enrollment
REGISTRATION FEE
If the Candidate postpones the plans of his/her intake within the Validity period. He / She is liable to pay if
there is any revision in the fee structure.
Date:
Place: Signature of the student
PARENT/GUARDIAN APPROVAL (Students below 18 yrs)
I support my son/daughter’s application to the University program as indicated above in section B. I agree
that the information contained in this application may be provided to the Counselor/International
Admission Office. I certify that the information above is true and complete.
Signature of the Parent/Guardian
INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED
Abroad Education Counsel
No. 19, MOBAS Tower, 1st Floor Bull Temple Road (Above Pizza Hut) Near Ramakrishna Ashram Circle
Basavanagudi Bangalore - 560004
Fixed Line +918041281672 Web: www.abroadeducounsel.com
