iEARN-Partnership for Learning
Youth Exchange and Study (YES) Program
Nomination Form for Independent Applicants
A-PARTICULARS OF SCHOOL:
Name of School: __________________________________________________
Address: __________________________________________________
___________________________________________ (paste your photograph here)
Telephone: ___________________________________________
B-PARTICULARS OF STUDENT:
Name: ___________________________________________
Date of Birth: ___________________________________________
Nationality: ___________________________________________
Class in which studying: ____________________________________________
Attach copy of the birth certificate
Classes studied in: 2003-2004: Grade and %age:
2002-2003: Grade.and %age:
2001-2002 Grade and %age
Attach photocopies of the marks sheet
Father’s Name: _______________________________________________
Father’s Occupation: _______________________________________________
Residential Address: ___________________________________________
_________________________________________________________________
Phone number residence: ________________________ Office: ____________
Students’ Email Address: ___________________________________________
Signature of the Student: __________________________________________
Signature of Parents: ______________________________________________
Signature and Seal of Principal: _____________________________________
Completed forms can be submitted faxed, mailed or submitted in person at the following address latest by 30th September 2004
iEARN-Pakistan , 206, New Kausar Square
Frere Town, Clifton Karachi-75530.
·
Write P4L-YES on the top of the envelope.·
Make sure you provide all correct and original information , if anything is found incorrect after verification the nomination will not be accepted.·
This is not the application form, the complete application form will be issued after the approval of this form.·
The acceptance of this form does not insure the acceptance in the program.·
Visit the web www.iearnpk.org/P4L-YES.htm for detailed information and updates................x................x.............