Management Studies, Gunupur

GANDHI INSTITUTE OF

MANAGEMENT STUDIES, GUNUPUR

APPLICATION FORM

FOR OFFICIAL USE ONLY (Do not write in this area)

Admn :Category:

Roll Number:

Details to be filled by the candidate in CAPITAL LETTERS

Submit six passport size photographs along with this form

Affix one Color passport Photograph

1. / Name of the student
(Surname first)
2. / Sex: Male / Female / 3.Date of Birth ………/ …………/ ……………………
4. Age ……………..yrs ……………..months / (till…………………………………)
5. JEE/MAT/CAT/OM ET Ro ll No :………………………… 6.Coursse……………………………….
JEE/MAT/CAT/ OM ET Rank No :…………………………………………………………………………
7. / Category(Tick one): General / SC
8.
Place of Birth:…………………………………………………………………………………………….
CITY/TOWN/ VILLA GE / DISTRICT / STATE
9. Details academic career (Matric,+2 and +3)
Sl. No / Name of Examination / Institute from which / Board/University / Year of / % of
passing / Marks
10. Do you have any chronic illness: / Yes: / No:
If yes mention the illness…………………………………………………………………………….
11. Blood Group……………………………………
12. Are you involved in any court proceedings: / Yes / No:
13.Write names of language known and indicate skills by placing a tick mark.
Languages known / Read / Write / Speak
14. Whether you have passport or not? / Yes : / No:

ORIGIONAL/XEROX CERTIFICATES ENCLOSED (Please Tick):

15. Mother Tongue…………………. 16. Nationality:……………… 17. Religion …………………..

18.Details of hobbies, extra -curricular interests, sports:………………………………………………….

19.Details of Father/ Guardian: Name:………………………………………………………………….. Occupation:…………………….. Designation:………………………… Organization:…………………………………………………………… Approximate Annual Inco me:…………………………………………..

20. Name of Mother: …………...………………………………………………………………………

21. Whether you wish to stay in the College Hostel: / Yes: / No:
(Write in CAPITAL LETTERS )
Present Address with PIN Code / Permanent Address with PIN Code
S/O/D/O:…………………………………… / S/O/D/O:……………………………………
C/O:………………………………………... / C/O:………………………………………...
At:…………………………………………. / At:………………………………………….
Po:…………………………………………. / Po:………………………………………….
Via:………………………………………… / Via:…………………………………………
P.S.:………………………………………... / P.S.:………………………………………...
Dist:……………….PIN:………………….. / Dist:……………….PIN:…………………..
State:………………………………………. / State:……………………………………….
Phone No with STD code:………………… / Phone No with STD code:…………………
Mobile No:………………………………… / Mobile No:…………………………………
e-mail I.D.:………………………………… / e-mail I.D.:…………………………………

DECLARATION BY THE CANDIDATE

I submit myself to the jurisdiction of the authorities of GIET/ GIMS and declare that I shall abide by its rules and regulations. I hereby declare that all particulars stated by this application and appendices are true. In the event of being found as given any incorrect in formation by me, GIET/ GIMS holds the right to cancel my ad mission.

Date:

Place:Full signature of the candidate

1. / HSC/ 10TH Class Certificate / 6.Conduct or character certificate (Original)
2. / HSC/ 10TH Class Mark sheet / 7. Migration certificate (Original)
3. / +2 or equivalent Certificate / 8. Caste certificate (SC/ST/OBC only )
4. / +2 or equivalent Mark sheet / 9. Resident/Nativity Certificate
5. / C.L.C./T.C.(Original) / 10.Green card

Migration Certificate should be submitted within one month from the date of admission

Change of address if any must be communicated to the office immediately .

In order to be considered for admission under the NRI and balance seat category, one has to send a state Bank of India A/c payee D.D for Rs.200/- in favour of ‘GIET,Gunupur’ towards the cost of prospectus and application form. The filled up application along with Xerox copies of certificates are to be sent to the Director of Admission, GIET, Gunupur, 765022, Dist. Rayagada , Odisha by Regd. Post. Allotments to the NRI seats are done and the same is communicated to the student by Regd. Post for joining.

Allotment to the balance seat category is done after the state Government counselling is over. This is usually done in the month of August. However, students who wish to be considered on priority basis can come to Gunupur in person, and go through the admission process. He / She shall deposit a sum of Rs.10000/(Ten Thousands only) as advance, which will be adjusted subsequently .