College Application Form

Dr. Mohanbhai I. Patel Institute of Excellence in Astronomy & Astrophysics

,

Changa – 388 421. Anand District. Gujarat

CHARUSAT CAMPUS

Ph# 91-2697-248202, 247500, 248133 Fax # +91-2697-247100

E-mail:

Website:

Application for Admission

Paste passport size

Form No : _____________

photograph in this space with

self-attestation (do not pin)

[ ] M. Sc. (Astronomy & Astrophysics)

[ ] M. Phil (Astronomy & Astrophysics)

[ ] Part Time

[ ] Full Time

[ ] Pre-Ph.D.

[ ] Part Time

[ ] Full Time

[ ] Ph.D.

[ ] Part Time

[ ] Full Time

Fees Rs. 1,00,000/- Per Year for any of the above Courses

1. Name in full (as in H. S. C certificate): _____________________________________________

2. Address for Correspondence:____________________________________________________

___________________________________________________________________________________________________

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Email: __________________________________________Telephone:__________ Mobile:_________________________

3. Native Place: ______________

4. Date of Birth (

) (Please attach proof of age):

Birth Place:_____________________

DD-MM-YYYY

5. Father’s Name: ________________________________ Mother’s Name: _____________________________________

6. Gender :

Male

Female

7. Marital Status: ____________________________________

8. Whether you belong to

SC

ST

OBC

General Category

9 Details of academic record (Attested copies of mark sheets / certificates to be enclosed)

Examination

Name of the

Board / University

Passing

Subjects

% of marks

Division

Examination

Year

or

Passed

Class

Higher Secondary

Bachelor’s Degree*

#Attach : Self Attested copies of mark sheets of above examinations along with school leaving certificate.

Issue of Application form does not automatically indicate eligibility for admission.

*Those who have appeared or appearing for final year examination can also apply. Give last 2 years details.

Submit duly filled application form accompanied by a At par Cheque /DD of Rs 1000/- drawn in favor of “Charotar

University of Science and Technology” payable at Changa or Anand

10. Application form fee : Bank DD No : ___________ Date :_____________ Payable at Bank:________________________

Bank Name: _______________________________________________________________________

Declaration:

I declare that all information provided by me in the application is true to the best of my knowledge and belief. I understand that I am

liable for prosecution if any of the information is found to be false at anytime in future.

Date

Signature of the Applicant

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For Office Use Only

Name of the Student: _____________________________________

Form No: ________________

Course Applied for : ______________________________________