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SI-UK Student Information Sheet

By completing this form, I give permission to SI-UK to enter my information into application forms for the
courses and schools listed under University Choice.

Personal Details

First Name: Family Name:


Gender: M Date of Birth: 00/00/0000
Nationality:Indian Country of Birth: India
Email: Phone Number:0
Passport No. : Passport start Date : 00/00/0000 end Date : 00/00/0000
Permanent home address (in English):
UK address including post code (if available):

Immigration Details (for student who has/had studied in UK before)

Date of first entry to the UK:


Date of most recent entry to the UK:
Do you need a visa to stay in the UK?
If the answer is yes,
1. What is your visa status?
2. When is your current visa expiry?
3. Have you ever been refused a visa to the UK?
Education Background

Dates of study Name of Institution Course Title Level of study, (eg.NQF Final/ Predicted
and Country Level, High School, Bachelor, Result
Master)

Start date:
End date:
Start date:
End date:
Start date:
End date:
Work/Internship experience (if available)

Job Title:
Name of organisation:
Address of organisation:
Dates: From To Till Date
Duties:
References (One for UG, two for PG):

Reference 1
Title: Position:
Name: Phone number
Work email: SI-UK e-reference:
Do you want to use an SI-UK e-reference?
Relationship to you: (eg. Employer, tutor, professor) professor
How long has the person known you?
Name of Institution:
Address of Institution:
References 2
Title: Position:
Name: Phone number:
Work email: SI-UK e-reference:
Do you want to use an SI-UK e-reference?
Relationship to you: (eg. Employer, tutor, professor)professor
How long has the person known you?
Name of Institution:
Address of Institution:
Do you have a disability?
No NO Yes (please state)
Do you have any criminal convictions?
No NO Yes (please state)

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