gsat 2019 brochuregsat.gitam.edu/images/gsat2019-application.pdf · gsat- 2019 application for...
TRANSCRIPT
GITAM INSTITUTE OF SCIENCE GITAM (DEEMED TO BE UNIVERSITY)
(Established u/s 3 of UGC Act, 1956)
VISAKHAPATNAM-530045+Accredited by NAAC with 'A ' Grade"
GSAT- 2019APPLICATION FOR ADMISSION TO UG & PG SCIENCE PROGRAMS
Note: Read the instructions carefully before filling this form. This sheet should not be mutilated or folded or stapled. Apply separately for each test
Program applied
Application Number
1. Test Code:
Registration Number (For office use only)
2 Name of the test center:
3. Name of the Applicant (in capital letters)
Surname
Name
4. Name of the Parent/Guardian
5. Date of Birth
Day Month Year
9. Particulars of Qualifying Examination
(a) Qualifying Examination: _____________
(b) Result Status : Completed / Awaited
10. Particulars of fee paid : DD No. Date :
Amount : Bank :
STD Code Phone No. Mobile No.
Phone Number
Email ID :
11. Address for Communication (CAPITAL LETTERS only)
6. Sex
Male / Female
8. Reservation Category (if any)
SC/ST/PH/Others
( c ) Group Subjects:
Subject 1 ________________________
Subject 2 ________________________
Subject 3 ________________________
Address : .............................................................................
.............................................................................................
.............................................................................................
.......................................... Pin: ...........................................
Aadhaar No.
Signature of the Applicant
7.
Nationality :
State :
Affix Latest Passport size Photograph
Preferred Centers*: 1_________________________ 2._______________________ 3._____________________
Anantapur, Bhimavaram, Eluru, Guntur, Hyderabad, Kadapa, Kakinada, Khammam, Kurnool, Ongole, Rajahmundry, Srikakulam, Tirupathi, Vijayawada, Visakhapatnam, Warangal, Bengaluru, Berhampur, Bhubaneswar, Dhanbad, Guwahati, Jamshedpur, Kolkata, Nagpur, Patna, Pune,Raipur, Rayagada, Siliguri, Varanasi
*(Tests will be conducted at the above centers depending on the number of candidates opting for those centers. If sufficient number of candidates do not opt for a particular center, they will be allotted to the near by center)
Details of qualifying examinations:
School/College Title of the Degree/ Qualification
Max Marks
Marks Obtained
% CGPA
Year of Passing
X / SSC*
Inter / 10+2*
Undergraduate*
(* Specify Title of the Degree Awarded)
Documents to be enclosed:
th Original Demand Draft Copy of 10 Pass Certificate Copy of 10+2 Pass Certificate
Copy of Degree Marks Statement if available Aadhar Card
I came to know about GIS through
Newspaper TV Alumni EducationFairs Internet Hoardings
Direct Enquiry Counseled by GIS staff Current Student Faculty &Staff
Declaration: I hereby declare that all the particulars stated in this application are true to the best of my
knowledge and belief. In the event of submission of incorrect or untrue information, I understand that my
admission is liable for cancellation. Further I understand that my admission is purely provisional and subject to
the fulfillment of the eligibility conditions. There will be no refund of Application Fee for any reason. I agree to
receive communication through SMS related to admission process. I shall abide by the rules and regulations of
GITAM (DEEMED TO BE UNIVERSITY).
Signature of the applicant with date
SIGNATURE OF PARENT/GUARDIAN
GITAM INSTITUTE OF SCIENCE GITAM (DEEMED TO BE UNIVERSITY)
(Established u/s 3 of UGC Act, 1956)Gandhinagar Campus, Rushikonda, Visakhapatnam-530045, A.P., India
0891-2840450/452 / 2790101, Telefax: 0891 – 2790032, website: www.gitam.edu+Accredited by NAAC with 'A ' Grade"
GITAM INSTITUTE OF SCIENCE GITAM (DEEMED TO BE UNIVERSITY)
(Established u/s 3 of UGC Act, 1956)Gandhinagar Campus, Rushikonda, Visakhapatnam-530045, A.P., India
0891-2840450/452 / 2790101, Telefax: 0891 – 2790032, website: www.gitam.edu+Accredited by NAAC with 'A ' Grade"
DUPLICATE
ORIGINAL
Program :
Test Code :
Test Centre :
Date of Examination
Name of the candidate
(in capital letters) ____________________________________________
Name of the Parent / Guardian ____________________________________________
Signature of the candidate ____________________________________________
Program :
Test Code :
Test Centre :
Date of Examination
Name of the candidate
(in capital letters) ____________________________________________
Name of the Parent / Guardian ____________________________________________
Signature of the candidate ____________________________________________
Hall Ticket No (to be filled in by the office)
Hall Ticket No (to be filled in by the office)
Recent Passport size Photograph
Recent Passport size Photograph
GSAT -2019GITAM Science Admission Test
UG & PG Programmes for the academic year 2019 - 20
HALL TICKET
GSAT -2019GITAM Science Admission Test
UG & PG Programmes for the academic year 2019 - 20
HALL TICKET