Himalayan International Summer Program 1997

( July 10 to Aug 4 )

Mr./ Mrs./ Miss........................... .................... .........................

(Family name ) (First name ) ( Middle name)

Permanent address : Present address:

PHOTO

Fax, Tel, Email Fax, Tel, Email

Country Place of Birth: Nationality Native Languages:

Date of Birth : Your English Knowledge: Poor Moderate

Single Married

In which college or university are you Presently enrolled? Or what is your academic Qualification?

List below courses you wish to take :

1 .

2.

3.

Do you want to apply for financial assistance . yes no

Please submit: 1. Application for admission 2. Transcript of your education 3. Service fees of 20 US$ or equivalent 4. One recent photograph (PP size ) 6. Statement of purpose (reasons of wanting to attend HISP )

Note : * Those who wants to apply for financial assistance should submit separate sheets of official documents of financial needs and references from your professor/ Instructor or employer.

application form can be make more copies if necessary.

I affirm that the information given in the application is complete as accurate.

_______________ ___________________

Date & Place: Applicants Signature: