Gender
*
Mr.
Ms.
Name
*
First Name
Last Name
Date of birth
*
MM
DD
YYYY
E-Mail
*
Starting Date
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Please tell me which month and year you ideally want to arrive in the country to study abroad.
(Example: 2025 September)
Country Preference
*
Which of these countries you would imagine studying in?
(You may choose multiple options)
Program Preference
*
(You may choose multiple options)
English Certificate
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Which of these English Test points are applicable to you (if any)? IELTS Academic overall score is considered.
(You may choose multiple options)
GMAT Certificate
*
Which of these GMAT Test points are applicable to you (if any)?
(You may choose multiple options)
How do you plan to finance your studies?
*
Personal savings
Parents & other relatives
I will take a loan
I am in need of scholarship or funding
My partner/sponsor will take care of it
What unis, schools or language schools you already applied to or contacted?
*
Please least all names here. Write NONE if there are none
Referral Name
(If you chose Family Member, Friend or Agency Referral as the source, please let me know the name of him/her so that I can say thank you!)
Student's Authorization Towards Agent's Services
*
I of hereby authorize Ms. Yana Immis to sign, process, collect or submit documents required for and related to admission to educational establishments: language schools, studienkolleg, private and state universities, colleges and business schools on my behalf. I declare that all above-mentioned documents processed by Yana Immis on my behalf will have the same impact as if they were directly processed by me. This authorization is valid from the application form submission date.
Student's Confirmation Towards Agent's Exclusivity
*
I of hereby confirm that I am aware of the Agent's policies and I agree to them:
1. Ms. Yana Immis does not and will not charge me any money for her consultations.
2. Ms. Yana Immis is my educational consultant (agent) exclusively and I will not seek help from other consultants without informing Ms. Yana Immis in a written form for permission to be granted.
3. If I would like to approach an alternative educational consultant I would request Ms. Yana Immis for permission, as Ms. Yana Immis does not work with sub-agents.
4. Ms. Yana Immis submits university applications' on my behalf, hence she is a subject of the universities' full premium/commission from the moment my documents or contact data has been shared with the institution.
GDPR Consent
*
Please note that prior to the capture of your personal data you are obliged to give your consent. If you do not consent to the processing of your data you will not be able to enter that data and subsequently unable to use this function of this website. Personal data is processed in all educational consultation systems (newsletters, calls, data sharing with educational establishments) and will be stored on the server of this website provider, located in Germany and in accordance with our data protection agreement with our service provider. By submitting this form, you are granting permission for Ms. Yana Immis to contact you. You may unsubscribe via the link found at the bottom of every email.
