Scribd
Upload
68 views3 pages

Application For1 22

This document is an application form for "Stream SX" submitted by Sokina Sorokhaibam. It provides her personal details such as name, date of birth, category, nationality, gender, and academic details. The form notes that her application is incomplete until she takes a printout, obtains the required signatures, pays the application processing fee, and submits all required documents by September 12, 2011.

Uploaded by

Binoy Singh Salam
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
68 views3 pages

Application For1 22

This document is an application form for "Stream SX" submitted by Sokina Sorokhaibam. It provides her personal details such as name, date of birth, category, nationality, gender, and academic details. The form notes that her application is incomplete until she takes a printout, obtains the required signatures, pays the application processing fee, and submits all required documents by September 12, 2011.

Uploaded by

Binoy Singh Salam
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
You are on page 1/ 3

APPLICATION FORM - 2011 Your application for "Stream SX" has now been incorporated into our system

and you have been assigned the Application number Stream SX 1 2 3 4 5

1175024.

Application No. 1175024

Name of Candidate (as in 10th Marks Card) : Sokina Sorokhaibam Date of Birth (dd/mm/yyyy) : 07/02/1995 Category : OBC Nationality : Indian Gender : Female Exam Board Science Maths Physics Chemistry Biology Others Aggregate 6 X Std CBSE 95 95 N/A N/A N/A N/A N/A (% marks) 7 XII Std CBSE N/A NA NA NA NA NA NA (% marks) 8 In the academic year 2011-2012 I have joined XII Standard in Science Subjects 9 Centre for writing Aptitude Test (for SA, SB and SX : Guwahati only) 10 Language in which would like to take your Aptitude : English Test 11 Name of College/Institution 12 Address of College/Institution : Jawahar Navodaya Vidyalaya Khumbong Manipur : Wangkhei Yonglan Leirak Wangkhei Yonglan Leirak Imphal. 795001 Manipur

Wangkhei Yonglan Leirak Wangkhei Imhal east Imphal Manipur 795001 09774710205 [email protected]

Candidate Signature:

CERTIFIED BY THE COLLEGE/INSTITUTION Ms. Sokina Sorokhaibam is a bonafide student of Jawahar Navodaya Vidyalaya Khumbong Manipur and her date of joining XII Standard in Science Subjects is on: and all the information furnished by the applicant is correct.

Date: Place:

Signature of the Head of the Institution Name: Institution Seal:

However, your application is not complete until you do the following: 1. Take a print out of this Application Form and make sure that it is complete with a application number and your signature. Please also obtain your School / College Principals signature and seal in the appropriate place. Do not make any changes / alterations to this page. 2. Application Processing Fee: * ** Processing fee for application is Rs. 200/- (Rs. 100/- for SC/ST candidate) by means of remitting Rs. 200/- (Rs. 100/- for SC/ST candidate) to any core banking branches of STATE BANK OF INDIA, payable at all branches in India. Paid into the credit of "Kishore Vaigyanik Protsahan Yojana(KVPY) A/c. No. 10270577392" and send the Pay-In-Slip (Applicants are instructed to download the Pay-In-Slip from KVPY web site http://www.kvpy.org.in/) along with the Application, clearly indicating the stream (SA, SX, SB, SP). Ensure that you also write the Application Number on the reverse of the Pay-In-Slip as well as other documents that you send along with this application. * Girl students are exempted from payment of processing fee. ** Physically and visually challenged students are also exempted from payment of processing fee. 3. For Stream SX The student aspiring to join undergraduate program in Basic Sciences for the session 2012 2013. 4. If you have obtained a letter grade in your qualification exam please convert into an appropriate % and fill-up in the application form.

5. Stream SP (Medicine) The application must be accompanied by two recommendation letters in the prescribed forms one form from Teacher / Instructor in your College/University and the other from the Advisor/Supervisor of your KVPY project (Bio-Medical Project). Each recommendation letters must be placed in different envelopes, sealed and with signature of the person giving the recommendation across the sealed envelopes. These sealed envelopes must accompany with your application. 6. Enclose the following : o Caste certificate in the case of SC/ST candidate o Medical certificate from the prescribed authority in case of physically and visually challenged candidates. o Project report in the case of SP Basic Sciences / Medicine o Original Pay-In-Slip of the Processing fee of Rs. 200/- (Rs. 100/- for SC/ST). o Attested copies of your marks statement of the qualifying examination(self attestation is acceptable ) for Stream SP only 7. Send all the above documents so as to reach on or before 12/09/2011 to The Convener, KVPY Indian Institute of Science Bangalore 560 012. 8. Last date for closing of online application is 9th September 2011 at twelve O clock midnight 9. You may check to see that your application is complete and all documents received at the KVPY office by going to http://www.kvpy.org.in. Please allow at least 20 days after sending your documents for postal delays for status information. 10. Issue of hall ticket through KVPY website (for online applicants only for SA, SX, SB): Website URL: http://www.kvpy.org.in/ Login ID Application number Password Date of Birth Application No. 1175024

You might also like