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Application Form

1. This document is an application form for admission to the M.Sc. (by Papers/Research) and Ph.D. programs at the Institute of Science in Mumbai. 2. The applicant agrees to abide by all rules regarding admission, fees, attendance, discipline, and prohibits ragging if admitted. 3. Personal information is requested including name, date of birth, category, qualifications, addresses, contact details, course and specialization preferences. 4. Instructions note the application must be submitted with a demand draft and copies of qualifications, with originals to be presented at admission.

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Kiran
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49 views

Application Form

1. This document is an application form for admission to the M.Sc. (by Papers/Research) and Ph.D. programs at the Institute of Science in Mumbai. 2. The applicant agrees to abide by all rules regarding admission, fees, attendance, discipline, and prohibits ragging if admitted. 3. Personal information is requested including name, date of birth, category, qualifications, addresses, contact details, course and specialization preferences. 4. Instructions note the application must be submitted with a demand draft and copies of qualifications, with originals to be presented at admission.

Uploaded by

Kiran
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Admitted to (M. Sc./ Ph. D.

) / Not Admitted Downloaded form Year 2010-11


Institute of Science, Mumbai-32 , Application For The Admission
FOR M. Sc. (By Papers/Research) and Ph. D.
MARKS OUT OF CATEGORY GEN.MERIT ENTERED/VERIFIED
/600 /800 LIST NO. BY

Photograph
The Director,
Institute of Science, 15, Madam Cama Rd, Mumbai 40032.
I have read the Prospectus. I hereby agree to abide by all rules regarding admission, Fees, attendance. I
hereby agree, if admitted, to abide by the rules & regulations at present in force or that may hereafter be enforced.
I undertake that I shall maintain the discipline and I shall not indulge in ragging activity of any kind. I submit
herewith a Provisional Eligibility Certificate from Mumbai University (For other University Graduates).

Course applied for:[ Write M. Sc. (by Papers/Research) / or Ph.D.] Subject …………………………
Specialization : (In order of preference) (For Chemistry, Physics, Zoology, Botany Students only) ( See Prospectus)

(1)………………………(2)……………………………….(3)………………………………. (4)
……………………………….
Name of the Student : (IN BLOCK CAPITALS):

:……………………………………………………………………………………………………………………………………
(Surname First Name Middle Name )

Mother’s name: ----------------------------------------------------------------------------------------------------------------------------------


Male / Female Nationality: ………Category: Open/O.B.C./ S.B.C./S.C. / S.T ./ N.T. /D.T / V.J---------
Date of Birth:…………………………………………………………………………………………………………………(Tick as applicable)

Name of the Guardian/Parent, Address, Occupation . ………………………………………………………. …………………


…………………………………………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………Tel No.…………………………………………
Present Address of the Student: ………………………………………………………………………….…………………………………
………………………………………………………………………………………………………………………………………………………
Mobile No. ………………………………………………………………Email address : ……………………………..……………………..
State whether you have applied or intend to apply for admission to any other course/ institution.

…………………………………………………………..
Demand draft No: Date: Bank & Branch
Qualifications: Furnish full details and explain breaks, if any, in educational career submitting evidence in support .
Degree Month &Year Subject at Marks Class % of Attempt &
of passing (B.Sc)/(M.Sc) Obtained/out obtained Marks Name of
of University
H. S. C./ XII ------------------
T. Y. B. Sc. /600
(Specify Univ.
/800
of
Mumbai /Other
M.Sc.
Addl. Qualification
B.Ed/M.Phil
Instructions: 1 Form must be submitted with a Demand Draft/Pay order drawn, in favor Yours faithfully,
of “Director, Institute of Science, Mumbai” payable at Mumbai of amount Rs. 300/-
2 Submit true copies of all qualifications, caste certificate etc. with application .. [-------------------------------------------------------]
3.Original certificates must be brought at the time of Admission. Round. . Applicant student’s Signature
4.reserach students should submit self addressed stamped ( Rs. 5.00 ) envelope with application. Date:

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