TEXILA AMERICAN UNIVERSITY

Student - Application form

Applied to University/College:

Country:

Preferred Course:

TO BE FILLED IN BLOCK LETTERS

1. Applicant's Name:
First Name Middle Name Last Name

2. Sex 3. Date of Birth: 4. Nationality:

5. Father's Name: Age: Occupation:

6. Mother's Age: Occupation:

Name:

7.Present Address: 8. Permanent Address:

Tel: Tel:

Mobile: Mobile:

E-Mail: E-Mail:

Fax: Fax:

7. Educational Qualification:

Name of School/College/University Last

attended:
Year of Qualification:
Completion :
8. Additional Qualifications :

Name of School/College/University Last

attended:
Year of Qualification:
Completion :
9. Applicants Passport No Date of Issue

Place of Issue Date of expiry

If the student / applicant holds, no passport at the time of applying ,please mention
when the student may receive new passport.

10. List of necessary documents to be attached:

PROOF of Date of Birth

Qualifying Examinations Transcripts

For Indian Nationals: 10 th Std, 11 th Std & 12 th Std...

For Other Nationals: Cambridge ‘O’ & ‘A’ level OR equivalent.
Transfer Certificate

Higher Secondary, Under Graduation(MBBS) Certificates /Transcripts along with Registration Certificate
copy.

Medical Certificates
One Passport size photograph – To be attached separately

DECLARATION

Signature of the
Signature of Parent /
Student
Guardian
Guardian

Date :

Place:

FOR OFFICE USE

Submitted on: File No:

By Person / Post

AO DO CAO

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