The educational history provided on the application indicates that the student will graduate/has graduated 4 or more


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Accounting of Time - Shokhjakhon



The educational history provided on the application indicates that the student will graduate/has graduated 4 or more 
months before the INTO program start date applied for OR there is a gap in the student’s academic history of 4 or 
more months. Please inform us if the student has taken additional educational courses or obtained any work history 
during this period. If so, please provide the dates of these activities. This information is required as part of the holistic 
review 
Educational History
during the academic evaluation for admission.
Student First/Given Name ______________________________________________________________________________
Student Last/Family Name _____________________________________________________________________________
Date of Birth (mm/dd/yyyy) _____________________________________
Proposed Program Start Date ___________________________________
Please check below:
I did not study during the time from the date of graduation to the proposed program start date. 
I did study during the time from the date of graduation to the proposed program start date. 
Please complete the information below: 
IF YOU HAVE LISTED AN ACADEMIC PROGRAM YOU MUST PROVIDE FULL TRANSCRIPTS FOR ALL COURSES 
TAKEN. Failure to disclose all required information and supply all relevant documents may be cause of 
application rejection or student dismissal.
By signing my name on this form, I certify that I have read the form instructions in full. The information I have provided 
is accurate.
Student signature _____________________________________________________ Date __________________________
Name, city & country of institution
Start Date
End Date
Level of Courses
High School
Vocational Studies
English language courses
Undergraduate 
Graduate
High School
Vocational Studies
English language courses
Undergraduate 
Graduate
High School
Vocational Studies
English language courses
Undergraduate 
Graduate
Shokhjakhon
Khabibullaev
01/17/2003
01/08/2023
01/24/2023

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