Registration for 2024 Session Grigol Robakidze University Admission Application Form Application Form1. General InformationName:Date of Birth:(dd/mm/yy):Place of birth: (City/Country):Citizenship(s):Gender: (Male/Female):Address:Phone:Skype:Email:Email (other):2. Information about desired programName of the program / qualification (major):Start Date:Date of accomplishment:School leaving certificate number:Home country entitlement to pursue higher education (Yes/No): 4. NEET QualificationNeet score:5. Information about language proficiencyDate of Birth:(dd/mm/yy):Place of birth: (City/Country):Citizenship(s):Gender: (Male/Female):6. Permanent address7. Name of Intermediary institution(s) / Agent(s) supporting your applicationDate of Birth:(dd/mm/yy):Citizenship(s):Gender: (Male/Female):8. Information about preferred Medical Licence examination (only MD Student) USMLE (USA) PLAB (UK) FMGE (INDIA)Other: SMC (USA) AMC (Australia)9. Confirm and Signature:I hardly confirm correctness and accuracy of submitted information and awareness that the provision of incorrect or inaccurate information may cause refusal of enrolment.Signature:Choose File Date:Passport size photo:Choose File Submit