Gandhi Institute of Management Studies

GANDHI INSTITUTE OF MANAGEMENT STUDIES, GUNUPUR APPLICATION FORM Affix one Color FOR OFFICIAL USE ONLY (Do not write in this area) passport Admn : Category: Photograph Roll Number:

Details to be filled by the candidate in CAPITAL LETTERS Submit six passport size photographs along with this form

1. Name of the student (Surname first) 2. Sex: Male Female 3.Date of Birth………/…………/…………………… 4. Age……………..yrs ……………..months (till…………………………………) 5. JEE/MAT/CAT/OMET Roll No:………………………… 6.Coursse………………………………. JEE/MAT/CAT/OMET Rank No:………………………………………………………………………… 7. Category(Tick one): General SC ST OBC 8. Place of Birth:……………………………………………………………………………………………. CITY/TOWN/VILLAGE DISTRICT STATE

9. Details academic career (Matric,+2 and +3) Sl. No. Name of Examination Institute from which passedBoard/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: 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 Income:………………………………………….. 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 information by me, GIET/GIMS holds the right to cancel my admission. Date: Place: Full signature of the candidate

ORIGIONAL/XEROX CERTIFICATES ENCLOSED (Please Tick): 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 favor 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 counseling 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.