LSLIT — Mentorship Programme Application

Section 1

Personal information

Tell us who you are.

Full name*

Email address*

Mobile number (with country code)*

Date of birth

Gender

Nationality

Country of birth

Section 2

Permanent address

Address line 1

City

State / Province

Postal code

Country

Section 3

Mailing address

Same as permanent address

Address line 1

City

State / Province

Postal code

Country

Section 4

Emergency contact

Full name

Relationship

Mobile number

Email address

Section 5

Visa history

Have you ever had a visa refusal / rejection?

Yes No

Section 6

Referee details

Referee name

Position / Designation

Institution / Organization

Institution address

Mobile

Section 7

Employment history (if applicable)

Job title

Organization name

Organization address

Employment from

Employment to

Section 8

Academic interests

Preferred level of study

Preferred programme / course

Preferred intake

Preferred study location (country / city)

Section 9

Academic qualifications

Complete whichever levels apply to you.

Secondary school (SSC / Grade 10)

Country of study

State / Province

Education board

Qualification awarded

Institution name

Result (out of GPA 5)

Start date

End date

Higher secondary (HSC / Grade 12)

Country of study

State / Province

Education board

Qualification awarded

Institution name

Result (out of GPA 5)

Start date

End date

Undergraduate

Country of study

State / Province

Qualification awarded

Institution name

Grading system & final result

Start date

End date

Postgraduate (if applicable)

Country of study

State / Province

Qualification awarded

Institution name

Grading system & final result

Start date

End date

Section 10

Required documents

Attach whichever apply to you. Accepted formats: PDF, JPG, PNG, DOCX, each up to 8MB. If you have more than one file for the same item, please combine them into a single PDF first.

Curriculum Vitae (CV)

Passport (bio-data page)

SSC Certificate

SSC Transcript

HSC Certificate

HSC Transcript

Undergraduate Certificateif applicable

Undergraduate Transcriptif applicable

Postgraduate Certificateif applicable

Postgraduate Transcriptif applicable

English Language Test ResultIELTS / PTE / TOEFL / Duolingo

Reference Letter(s)

Employment Certificate(s)

Visa Refusal Letter(s)

Declaration

I declare that the information provided in this application is true and complete to the best of my knowledge.

Full name (as signature)*

Date