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Student Self Assessment Form

This document is a student self-assessment form containing personal details such as name, address, contact information, educational background, intended program of study, skills, interests, and standardized test scores of Isha Meshram. According to the form, Isha is a female Indian citizen currently residing in Thane, Maharashtra, India. She has completed her diploma in petrochemical engineering, bachelor's degree in chemical engineering, and master's degree in technology. Her intended program of study is a PhD in chemical engineering beginning in spring 2023. She is proficient in English and has skills in polymer and ammonia manufacturing as well as software like Python and AutoCAD.

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Isha Meshram
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59 views6 pages

Student Self Assessment Form

This document is a student self-assessment form containing personal details such as name, address, contact information, educational background, intended program of study, skills, interests, and standardized test scores of Isha Meshram. According to the form, Isha is a female Indian citizen currently residing in Thane, Maharashtra, India. She has completed her diploma in petrochemical engineering, bachelor's degree in chemical engineering, and master's degree in technology. Her intended program of study is a PhD in chemical engineering beginning in spring 2023. She is proficient in English and has skills in polymer and ammonia manufacturing as well as software like Python and AutoCAD.

Uploaded by

Isha Meshram
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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STUDENT SELF ASSESSMENT FORM

Full Legal Name (please type or print legibly)


Last First Middle
MESHARAM ISHA SURENDRA

Maiden Name Previous Last Name

Student's Address (Home Address)


Number/Street/Apt . City
A1- 1405 BHOOMI LAWNS, KALYAN SHILL ROAD THANE

State Zip Code Country


MAHARASHTRA 421205 INDIA Country

Telephone
Area Code (Home) Email Address (required)
+91 8369 [email protected]

Gender and ethnicity are required by the U.S. Department of Health, Education and Welfare under the provisions of Title VI of the Civil Rights
Act and may not be used for discriminatory purposes.

Residency Status Country of Birth: INDIA Citizenship: INDIAN

Date of Birth: 19-03-1996 Sex/Gender: ☐ Male  Female

Emergency Contact Information:


Last Name First Name Middle
MESHRAM SURENDRA NAMDEO
Relationship ☐ Spouse  Guardian  Parent ☐ Other

Address:
Number/Street/Apt . City
A1- 1405 BHOOMI LAWNS, KALYAN SHILL ROAD THANE

State Zip Code Country


MAHARASHTRA 421204 INDIA

Telephone:
Area Code (Home) Area Code (Work)
+91 9757165338

High School Information


Name and Address of high school attended

ST. MARY’S CONVENT HIGH SCHOOL, URAN MAHARASHTRA INDIA 2011


Name of School City State Country Month/Year Graduated

College and University Information


List of all the colleges and universities you have attended whether or not credit was earned.

Name of College City State From(mm/yy) To(mm/yy) Degree GPA


VISHWAKARMA PUNE MAHARASHTRA 01/2021 06/2022 MTECH 9.5
INSTITUTE OF
TECHNOLOGY,

SHIVAJIRAO. S. MUMBAI MAHARASHTRA 06/2017 10/2020 B.E 7.25


INSTITUTE OF
JONDHALE COLLEGE
OF ENGINEERING

INSTITUTE OF RAIGAD MAHARASHTRA 06/2011 06/2016 DIPLOMA 6.64


PETROCHEMICAL
ENGINEERING

Intended Program, Specialty & Term You wish to begin Study


Fall 20 Spring 2023 Specialty: PhD IN CHEMICAL ENGINEERING

Mode of Education
Online  Offline 
Undergraduate  Bachelors Level
 Non-Degree Taking Undergraduate Coursework
 Intensive English Program

Graduate  Masters Level


 Doctoral Level
 Graduate Certificate
Medicine ☐ Dentistry ☐ Nursing ☐ Chiropractic ☐ Other Allied Health Professions ☐

Honors, Scholarships and Awards:


Extracurricular Activities:

PARTICIPATED IN PAPER PRESENTRATION, WRITER TO ANATHALOG.

Skills, Interests Projects

 Manufacturing or Reinforced Fibers Polymeric Material


 Manufacturing of Ammonia

Software

DWSIM, PYTHON, PDMS, AUTO CAD, CO-CO SIMULATOR, CHEMSSP

Volunteer Activities:
Organization Name
Dates of Employment 11-05-2022 to 12-05-2022
Position/Title
Hours/Week
Description

Organization Name
Dates of Employment 27-04-2022 to 10-05-2022
Position/Title
Hours/Week

Description

Languages/Fluency
For languages other than English, please indicate your verbal and written proficiency.

Language 1

Language ENGLISH

Verbal Advanced

Written Advanced

Language 2

Language Select Language

Verbal Choose an item.

Written Choose an item.

Language 3

Language Select Language

Verbal Choose an item.

Written Choose an item.

Standardized Test Scores and Dates Taken

English Proficiency IELTS/TOEFL NA


Cambridge NA
SAT/ACT NA
GRE/GMAT NA
LSAT NA
MCAT NA
USMLE Step 1 NA
USMLE Step 2 NA
USMLE Step 3 NA
NLN PAX/NET NA

Please fill in accurately as much information as possible so we can help design the perfect program to
realize your college dreams. If not applicable, please fill ‘NA’ in the relevant box .

Certification:
I certify that the information given by me on this application is complete and accurate, and that
all materials submitted as mine are entirely my own. I understand that willful misrepresentation
or failure to disclose complete and accurate information may result in the disqualification of my
application.
ISHA MESHRAM SURENDRA 6/18/2022

Signature of Applicant Parent Date

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