ইন্টারন্যাশন্াল সার্ভিস সসন্টার International Service Center

h‡kvi weÁvb I cÖhyw³ wek¦we`¨vjq Jashore University of Science and Technology

h‡kvi 7408, বাাংলাদেশ Jashore 7408, Bangladesh
Phone: +880-421-61199, E-mail: international.admission@just.edu.bd

Application Form
(For Admission into Undergraduate (Bachelor Degree), Postgraduate (Master’s Degree) and
Research Programs (M.Phil./Ph.D.) for foreign students)

SECTION I
(Applicant’s
Name of Department: 55X45 mm color
photograph)
Desired Degree: Bachelor's Master's M.Phill PhD

Academic Session:

Personal details

Title (Mr./Ms./Mrs.) : Family name / Surname:

First Name: Middle Name:

Father’s Name:
Mother’s Name:

Passport number: Gender: M F Others

Date of Birth : D D M M Y Y Y Y

Nationality:
Present address
Street Address/Village:

District: State
:
Country: Postcode
:
Telephone: Fax:

Mobile: Email
:
Permanent Address
Street Address/Village:

District: State
:
Country: Postcode
:
Telephone: Fax
:
Mobile: Email
:

Page 1 of 4
 ইন্টারন্যাশন্াল সার্ভিস সসন্টার International Service Center
h‡kvi weÁvb I cÖhyw³ wek¦we`¨vjq Jashore University of Science and Technology
h‡kvi 7408, বাাংলাদেশ Jashore 7408, Bangladesh
Phone: +880-421-61199, E-mail: international.admission@just.edu.bd

Contact Person in Bangladesh (if any):

(Name, Email and Phone)

Contact Person at Home:

(Name, Email and Phone)

Educational Background
Result CGPA/
Year of Duration of
Name/type of Study (Grade/ Marks
Institution/Board/Authority Completion
Examination (%)
Division/Class)

SECTION II
Background Information
(a) Within the last two years, have you or your family member even had tuberculosis of the lungs? Yes No

If ‘Yes’ provide details:

(b) Do you have any physical or mental disorder that would require social and/or health services? Yes No

If ‘Yes’ provide details:

Page 2 of 4
 ইন্টারন্যাশন্াল সার্ভিস সসন্টার International Service Center
h‡kvi weÁvb I cÖhyw³ wek¦we`¨vjq Jashore University of Science and Technology
h‡kvi 7408, বাাংলাদেশ Jashore 7408, Bangladesh
Phone: +880-421-61199, E-mail: international.admission@just.edu.bd

(c) Have you ever been refused a visa or permit, denied entry or ordered to leave Bangladesh or any other country?

Yes No

If ‘Yes’ provide details:

(d) Have you previously applied to enter or remain in Bangladesh? Yes No

If ‘Yes’ provide details:

NoHave
(e) Subject Matter
you ever No
committed, been arrested for, been charged with or convicted of any criminal offense Yes country?
in any
Yes No
1. (a) Within the last two years, have you or your family member even had
No Subject Matter
tuberculosis of the lungs No Yes
If ‘Yes’ provide details:
1. (a)
(b) Within
Do youthe lastany
have twophysical
years, have you or
or mental your family
disorder member
that would even social
require had
tuberculosis of the lungs
and/or health services?

(b) Do you
(c)have anyprovide
Please physicaldetails
or mental
if youdisorder
answeredthat‘Yes’
would
to require
questionsocial
1(a) and/or 1(b).
(f) Are you, or have
and/or healthyou ever been a member or association with any political party, or other group or organization which
services?
has engaged in or advocate violence as a means to achieving a political or religious objective, or which has been
(c) Please
associated with criminal provide
activity details
at any time?if you answered ‘Yes’ to question 1(a) and/or 1(b). Yes No

If ‘Yes’ provide details:

No Subject Matter
SECTION III No Yes

No
1. Subject
(a) WithinMatter
Declaration
the last two years, have you or your family member even had No Yes
2. (a) Have you ever been refused a visa or permit, denied entry or ordered to
tuberculosis of the lungs
I,1.the
undersigned,
leave
(a) the do
Bangladesh
Within lasthereby
or any
two declare
other
years, that
you the
country?
have details
or your given
family above
member evenarehad
true. I also declare that I will
always tuberculosis
abide by theofrules and regulations of this university and will not take part in any activities that
2. (b)
(a) Do you
Have youhavethe
anylungs
physical or mental disorder that would require social to
damage (b)its you ever
reputation.
Have Ibeen
previouslywill refused a visa
also refrain
applied to enter ororpermit,
from denied
committing
remain entry
any or
in Bangladesh?actordered
subversive of the interests of
and/or
Bangladesh health services?
leave
(b) Door discipline.
Bangladesh
you have any orI understand that submission
any otherorcountry?
physical mental disorder thatof would
false or misleading
require social information may result in
the cancellation (c)
of my studentship
Please at thisifuniversity.
provide details you answered ‘Yes’ to question 2(a) and/or 2(b).
(b) Have (c)
youPlease provide details if youor answered
remain in‘Yes’ to question 1(a) and/or 1(b).
and/or health services?
previously applied to enter Bangladesh?
(c) Please provide details if you answered ‘Yes’ to question 1(a) and/or 1(b).
(c) Please provide details if you answered ‘Yes’ to question 2(a) and/or 2(b).

(Signature of Applicant, electronic signature accepted) Date: D D M M Y Y Y Y

Page 3 of 4
 ইন্টারন্যাশন্াল সার্ভিস সসন্টার International Service Center
h‡kvi weÁvb I cÖhyw³ wek¦we`¨vjq Jashore University of Science and Technology
h‡kvi 7408, বাাংলাদেশ Jashore 7408, Bangladesh
Phone: +880-421-61199, E-mail: international.admission@just.edu.bd

==================================================================

Documents (certified photocopy or scanned copy of originals) to be attached:

1. All academic certificates and transcripts

2. A recent photograph (please see the admission circular for photo specification)
3. A curriculum vitae
4. English proficiency certificate is not required, however, candidates with minimum 5.5 IELTS or 65
TOEFL score can apply for scholarships.
5. Certified photocopy or scanned copy of passport.
6. A statement of purpose
7. A letter of reference from the applicant’s last academic institution.

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