inter-State Educational Institution of Higher Education

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inter-State Educational Institution of Higher Education

“Belarusian-Russian University”

Form for receiving an invitation to study

* The form should be completed in block letters

** The form and all the attached documents should be sent to the International Department of Belarusian-Russian University by post or/by fax or/ by e-mail

Contact point:

Prospekt Mira 43, 212000 Mogilev, Republic of Belarus

Tel/fax: +375 222 25 28 30

e-mail: interstudy@bru.by

1. PERSONAL INFORMATION

Family name: DENIS DILAND DIAGHA KANG Name:

                                      (as it’s written in the passport)                                     (as it’s written in the passport)

Patronymic(if available):                                    

Sex:              Date of Birth: 28 .11.1999       Nationality: Cameroun

    (male/female)                                   (day/month/year)

Passport №: 1927956                  Date of issue:                    Date of expiry:

                                                                              (day/month/year)                         (day/month/year)

Home address: yaounde st: Joseph tchooungui akoa 121                                                            

Home telephone number:                                 Mobile phone: +237 90272749                       

                                   (Specify phone numbers using an international format, e.g. +375 4477834 45 )

E-mail:                                    Fax:                                               

Father:

       Surname, Name, Patronymic: Augustin kang Willy                                                            

       Place of employment, position:  electrician                                                                           

       Contact number:                                                                                                                    

Mother:

       Surname, Name, Patronymic: Emmerancia                                                                           

       Place of employment, position: doctor                                                                                  

       Contact number:                                                                                                                    

Where are you planning to get a study visa?                                                                                

              (specify the diplomatic representation of the Republic of Belarus where you are planning to get a visa)

2. PREVIOUS EDUCATION

Kind of education *

Name of the educational institution

Period of education (from…to…)

Document (certificate, diploma and etc.) **

Secondary education

high school diploma

Special /vocational education

Higher education

* Specify all the educational institutions where you studied

** Attach the documents confirming your education (certificate, diploma and etc.)

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