Application Form for Bioscience.cdr

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Application Form for Bioscience.cdr
No.
SCMS SCHOOL OF TECHNOLOGY AND MANAGEMENT
(Bioscience and Biotech Division)
South Campus, Management House, S. Kalamassery, Cochin - 682033
Ph: 0484-2558502, 2256315 Fax: 91-484-2540482 Web.scmsgroup.org/sstm, email: [email protected]
APPLICATION FOR ADMISSION TO
M.Sc. MOLECULAR BIOLOGY & GENETIC ENGINEERING
M.Sc. BIOMATERIALS & TISSUE ENGINEERING
M.Sc. GENOMICS & PROTEOMICS
M.Sc. TOXICOLOGY
(Tick 3 whichever is applicable)
Last date for receipt of filled in application ......................................................
Instructions for filling the Application Form
1) Fill in the application form in Capital Letters only.
2) Please enclose attested photocopies of all testimonials along with the form.
All certificates (originals) should be produced at the time of interview.
3) Make sure you sign and put the date on the form.
4) Partially filled up or incorrectly filled up applications will be summarily rejected.
AFFIX YOUR
LATEST
PHOTOGRAPH
HERE
1. Name as in the Matriculation (Class X) Certificate (CAPITAL LETTERS ONLY)
………………………………………………….......………………………………………………………
2. Gender
Male
3. Age & Date of Birth
Female
years , DD
TG
MM
YYYY
4.
Nationality
………………………………………Religion…………….……………..…….…………….
5.
E-mail id .........................................................................................................................................
6.
Whether belonging to reservation category
Yes
No
If yes, name the category ...................................................................................................................................................
7. Permanent Address ............................................................................................................................................................
..........................................................................................................................................................................................
State………………………..……………..............……………………PIN………...............................………………………….
8. Mailing Address……………………………….……………..………………………………………...….…………..……..………..
…………………….……………..……………………………………………………..………………………...…..………..…….…
State…………………………….....………………..…….................................………PIN…………………....……………..……
9. Contact Telephone No.…………….............……….............................….
Mobile ………….….......……………………..….
10. Father’s Name……………………………………………………………...............……………..…………………………....…….
E-mail id ........……………………………………………………………...............……………..………………………..…..…….
Occupation…………………………………..........
Contact Phone….……….………..........…………..
11. Mother’s Name……………………………………………………..………………………………..………………………..…...….
E-mail id ........……………………………………………………………...............……………..…………………………....…….
Occupation…………………………………….……
Contact Phone ….……….…………….………...…
12. Qualification (enclose attested copies of Certificates)
Stage
Particulars
Board/University
Year of Passing Class % of marks
Secondary School
Higher Secondary/
Plus two
Graduation
Post-Graduation
Others
13. Work experience (if any)
Period
Designation
Office Address
14. Documents to be submitted along with the application. (failure to submit photocopies of relevant certificates
will disqualify the application).
Secondary School Certificate
Higher Secondary
Graduation
PG/Professional
Stamp size photo
Registration Fee/DD
15. Hostel facilities required : Yes
No
DECLARATION BY THE APPLICANT
I hereby declare that the information given by me in this application is correct to the best of my knowledge and belief. In the
event of securing admission, I agree to abide by all relevant rules and regulations of the SCMS School of Technology and
Management.
Place :
Signature
Date
Name
:
DECLARATION FROM GUARDIAN / PARENT
I hereby agree to whatever that has been stated above by my son / daughter / ward in respect of his / her enrolment at the
SCMS School of Technology and Management .
Place :
Signature
Date
Name
: