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STATE UNIVERSITY
International Graduate College Application
INTERNATIONAL GRADUATE
Submitted date: 12/13/2014
Application fee paid: $100.00
Application ID: 136872
1. APPLICANT INFORMATION
Full legal name as it Patel
appears in passport:
(FAMILY/SURNAME)
Rajat
Hareshkumar
(FIRST/GIVEN)
(MIDDLE)
Variations of name:
Female
Use the following codes for the questions below: F1 (Student), J1 (Exchange Visitor), H1 (Worker), F2, J2, H4 (Dependent), B1, B2 (Visitor), OT(Other).
Indicate the type of visa you wish to hold while enrolled: F-1
Do you have any dependents who will accompany you?
If yes, indicate:
Spouse; Children:
1;
2;
3;
No
4+
Yes
No
Rambaug Lane-4
Rambaug Lane-4
Kalyan(W)
(CITY)*
India
(COUNTRY)
Maharashtra
Kalyan(W)
(PROVINCE/STATE)*
Maharashtra
(CITY)*
421301
(PROVINCE/STATE)*
India
(POSTAL CODE)
421301
(COUNTRY)
(POSTAL CODE)
, or a distance
program?
Teaching assistantship
Research assistantship
Please list names of specific faculty you have an interest in working with for your graduate program:
Dr.Chang Morris, Dr. Phillip Jones, Dr. Akhilesh Tyagi
Have you previously attended Iowa State?
Yes
No
Both
INTERNATIONAL GRADUATE
Submitted date: 12/13/2014
Application fee paid: $100.00
Application ID: 136872
2. PREVIOUS EDUCATION
Provide the following information for all postsecondary universities attended, including any you are currently attending, starting with
the most recent. (Note for Indian applicants: please list the university that awards the final examination mark sheets and/or degree.
DATES ATTENDED
8/2010 - 6/2014
NAME OF UNIVERSITY
LOCATION
Shivaji University.
Kolhapur, Maharashtra
and
What was your undergraduate major? Electronics
Telecommunication Engineering
B.E.
Graduate major?
Please provide your cumulative GPA for the institution(s) in which you earned (or will earn) a degree, using the grading system used
at your institution. (See the How to Apply section for assistance in completing this question.)
Undergraduate GPA:
Graduate GPA:
3. EXAMINATIONS
SECTION
SCORE
PERCENTILE
GRE VERBAL
152
54
GRE QUANTITATIVE
159
74
3.0
15
MO/YR TAKEN
10/2014
GRE SUBJECT
GMAT TOTAL
95
TOEFL (IBT)
08/2014
IELTS
4. RECOMMENDATIONS
List below the names, institution or company, and email addresses or the three people who will submit letters of recommendation for
you. Your recommenders will be contacted by e-mail with instructions on how to submit their recommendation online. If they prefer not
to do so, they may complete the Graduate College Letter of Recommendation form available at
wwww.admissions.iastate.edu/apply/index.php. Under the Family Educational Rights and Privacy Act of 1974, you may decide
whether letters of reference written at your request are held confidential or whether they are to be available for your personal
inspection. Do you waive the right provided by the Family Educational Rights and Privacy Act of 1974 (Buckley Amendment) to view
these recommendation letters in your file at Iowa State? Yes
No
TITLE
FIRST NAME
LAST NAME
INSTITUTION/
COMPANY
USE ONLINE
PROCESS?
Mr.
Veeresh
P.M.
Bharati Vidyapeeth's
College of Engineering,
Kolhapur
veeresh.64@gmail.com
Ms.
Jayamala
Patil
Bharati Vidyapeeth's
College of Engineering,
Kolhapur
jayamala.p@rediffmail.com
Mr.
Sanjay
Pawar
Bharati Vidyapeeth's
College of Engineering,
Kolhapur
pawarsanjay2@rediffmail.com
INTERNATIONAL GRADUATE
Submitted date: 12/13/2014
Application fee paid: $100.00
Application ID: 136872
5. ACTIVITIES
List your activities since secondary school, including any significant periods of time (other than vacation periods) in which you were
not studying.
INCLUSIVE DATES
LOCATION
8/2010 - 6/2014
Bachelor's of Engineering,
Kolhapur, Maharashtra
8/2014
Mumbai, Maharashtra
6. CONDUCT
Have you ever been charged with or subject to disciplinary action for scholastic or other type of misconduct
at any school?
Yes
No
Do you have a pending criminal charge OR have you ever been convicted of a crime, made a plea of guilty
or no contest, accepted a deferred judgment, or been required to register your name a home address with
a local or state law enforcement agency? (Misdemeanor traffic offenses are exempt.)
Yes
No
If you answered yes to either of the above questions, please explain below.
BY SIGNING BELOW, I CERTIFY THAT ALL STATEMENTS IN THIS APPLICATION ARE COMPLETE AND TRUE.
APPLICANT'S SIGNATURE: Rajat Hareshkumar Patel
DATE: 12/13/2014
INTERNATIONAL GRADUATE
Submitted date: 12/13/2014
Application fee paid: $100.00
Application ID: 136872