UME Ala UNIVERSITY CSM Pola) APPLICATION FORM FOR ADMISSION TO FACULTY: cul Affix signed PROGRAMME: passport size photograph BRANCH: ACADEMIC YEAR: First Name| Middle Name Last Name Name of the Candidate (in BLOCK letters) (AS appearing in the Class X Marks Card) Aadhar Card Number als Gender (Please tick the appropriate one) | Male / Female / Transgender Father's / Husband's / Guardian's Name Father's / Guardian's Occupation Mother's Name sfofals Mother's Occupation Combined Annual Income Father's Income [Mother's Income [ Total Income (Both Father's + Mother's) Permanent Address Address for Correspondence Flat/House No: Street/Cross/Road Village/Town/city District State PIN: Mobile No. Alternate No. Candidate's E-mail Parent's E-mail Registered as M.S. Ramalah University of Applied Sciences University House, Gnanagangothri Campus, New BEL Road, MSR Nagar, Bengaluru - 560 054, Karnataka, India. T #9180453 6665 | F #9180 45366677 | W wwwmsruasacin10 Local Guardian's Name & Address PIN’ Mobile No. Local Guardian's E-mail 1 Nationality 2 Date of Birth 1% State of Domicile Blood Group Religion (Please tick the appropriate one) Hindu / Muslim /,Christian/ Sikh, Jain / Buddhist / Parsi Category (Please tick the appropriate one) om | sc | st | osc] pH [Others 7 Name of Qualifying Examination Passed ‘Aggregate Percentage (%) of Marks / CGPA Percentage (%) of Marks in Core Subjects (Specify Subjects[PCB/PCM] with % of Marks) Medium of Instruction Name of the Board / University and Location Name of the Institution Last Attended and Location Registration Number as appearing in the Qualifying Marks Card Year & Month of Passing Entrance Examination Details: Exam Name: Roll No. Score! Extra-Curricular Activities & Achievements at School, State, National Level (if any) 20 Source from where you got the information about the University: Newspaper/ Website/ Search Engine/Notice Board/ Brochure/ Education Fairs/ Word of Mouth/ Others:Documents to be Submitted at the time of admission: 21 _ | Original + three sets of self-attested copies + 6 pass port size photographs (Original Marks Cards / Certificates will be returned after verification & admission approval.) 4, Entrance Test Score Card (if applicable), Undergraduate Programmes: 6, Transfer Certificate (From last attended 1, Class Ten / SSLC Marks Card educational institution) 2. Two-Year-PUC or Class Xil Marks Card 7. Migration Certificate (for students from Non- 3. Diploma Marks Cards (for Lateral Entry Karnataka PU Boards) admissions) 8. Copy of Aadhar Card 4. Entrance Test Score Card (if applicable) 9. Copy of Driving License/Passport/Pan Card. 5. Study Certificates (if applicable) Postgraduate Programmes: 7. Internship/Attempt Certificate (es 1. Class Ten / SSLC Marks Card applicable) 2. Two-Year-PUC or Class Xi Marks Card 8, Transfer Certificate (From last attended 3, U G Degree Marks Cards ‘educational institution) 4, Degree - PDC or Convocation Degree 9. Migration Certificate (for students from Certificate other Universities) 5, Entrance Test Score Card (if applicable) 10. Copy of Aadhar Card 6. Study Certificate (if applicable) 11. Copy of Driving License/Passport/Pan Card Ph.D. / Doctoral Programme: 5. Work Experience letter (as applicable), 1. Class Ten / SSLC Marks Card 6. No Objection Letter from the employer (as 2. PG Degree Marks Cards applicable) 3, Degree - PDC or Convocation Degree 7. Copy of Aadhar Card, Certificate 8. Copy of Driving License/Passport/Pan Card (AIU), New Delhi Students from Foreign Countries, PIO, NRI Students are required to submit copy of Valid Passport, Student Visa, Citizenship Card, Sponsorship Letter (if applicable) and for student possessing foreign qualification / Degree should produce Equivalence Certificate from Association of Indian Universities Declaration by Student & Parent I. Mr./ Ms, Mr./ Ms. pursing the UG / PG /PhD Degree Course in, admitted to your University for. Father / Mother / Guardian of student Semester / Year for hereby declare that | am aware of my financial obligation and | confirm that I can afford to pay all the costs and undertake to pay the tuition and other fee payable to the University under the rules and regulations framed from time to time by the University. TOTAL FEE DETAILS FOR THE ENTIRE COURSE: roar (Rs. 02 03 04 05, 06 TOTAL FEE FOR THE ENTIRE COURSE Date Signature of Candidate Signature of Parent/ Guardian