All’Ambasciata d’Italia di Dhaka

PERSPECTIVE STUDENT INFORMATION SHEET

Details of the Italian University where you wish be enrolled

Name of the University

___________________________________________________
SAPIENZA UNIVERSITY OF ROME

Name of the course

_______________________________________________________
APPLIED COMPUTER SCIENCE AND ARTIFICIAL INTELLIGENCE

Language of the course

___________________________________________________
ENGLISH

Applicant’s data

Name ___________________________________________________
SAMEER MOHAMMED SHAFIUL AZAM

Family name_______________________________________________
AZAM
Sex_________
MALE

Date and place of birth

___________________________________________________
3RD JANUARY 2004, CHATTOGRAM.

Address
________________________________________________________________
1850/A, IMTIAZ MANSION, FLAT#09, 2ND FLOOR, 25 WEST RAMPUR, SABUJBHAG
HALISHAHAR, CHATTOGRAM.
Phone number
__________________________________________________________
+8801645098533

Email address (in capital

SAMEERMSAZAM@GMAIL.COM
letters)___________________________________________

Are you using an agent for your enrollment procedure?

Yes [ ] Name and contact number of your agent
NO
___________________________
No [✓]

Highest Bangladeshi study degree/qualification (HSC, BSc, MSc, PhD…)

HSC
_____________________________________________________________________
___

Issuing School/College/University
__________________________________________
GOVERNMENT HAZI MOHAMMAD MOHSIN COLLEGE

Final score and year GPA

__________________
5.00, 2022

6.5
IELTS SCORE_______________________released on_____________________
24th march, 2023

Can you speak Italian? ___________________________

NO
I declare that the information I gave above is true and I am aware that all
contacts from the embassy will be through my email address and that no change
will be allowed after submitting this form.

Date _________________ Signature