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  Application Form
MANGALA INSTITUTE OF MANAGEMENT STUDIES
(Affiliated to Bangalore University, Approved by Govt of Karnataka, Recongnised by AICTE New Delhi)
Site No. 6. 'DEVADIGA SOUDHA', 3rd 'D' Cross, Ideal Home Township, II Phase, Rajararajeshwari Nagar,
Bangalore - 560 098, INDIA Tel: 080-28602670 Fax: 080- 28601200
 
APPLICATION FORM NUMBER
Note: 1. Use Capital letters with ball point pen to fill the application form
2. Attach attested copies of the mark cards/documents
 
  Applied for (Name of the Course)  

1.		   NAME OF THE STUDENT
  (As in the qualifying degree certificate) 		 

      
2.
Attach attested copies of the marks cards/documents
3.
  SEX  MALE FEMALE  
4.   PARENTS/GUARDIAN'S NAME  
5.   PARENT'S/GUARDIAN'S OCCUPATION  
6.   MOTHER TONGUE  
7.
  DO YOU REQUIRE HOSTEL? YES NO  

8.		   
  ADDRESS FOR CORRESPONDENCE		  
 
    PINCODE STATE  
    TEL. NUMBER      

9.		   
   PERMANET ADDRESS 		 
 
    PINCODE STATE  
    TEL. NUMBER      
10.
  PERCENTAGE OF MARKS IN 10TH   STANDARD  
CLASS OBTAINED
 
11.   BOARD/SCHOOL OF STUDY  
12.   YEAR OF PASSING (IN HIGH SCHOOL)  
13.   QUALIFYING PLUS 2 COURSE
  (PUC/PDC etc) or 12Th STANDARD		  
14.
  Aggregate percentage of marks in plus 2 or equivalent exam and class obtained.
  
  CLASS OBTAINED  
  Percentage of marks in plus 2
or equivalent exam in Mathematics		            
15.   BOARD/SCHOOL/COLLEGE OF PLUS 2 STUDY  
16.   YEAR OF PASSING (PLUS 2 STUDY)  
17.   QUALIFYING BACHELORS DEGREE COURSE
  (B.E/B.Tech/B.A./B.Com./B.Sc/B.B.M. etc)		  
18.
  PERCENTAGE OF MARKS IN DEGREE COURSE   CLASS OBTAINED  
19.   YEAR OF PASSING  
20.   COLLEGE/UNIVERSITY OF DEGREE COURSE
21.   DISTINCTIONS/ACHIEVEMENTS
A
   
B
   
C
   
 
22.   EXTRA-CURRICULAR ACTIVITIES
A
   
B
   
C
       
23.   SIGNATURE OF THE STUDENT
24.   SIGNATURE OF PARENT
25.   PLACE
26.
  DATE      
27.
   CHECK LIST FOR DOCUMENTS
(Documents to be sent with application form. Please tick/cross the box)
 
 
 
A
 ATTESTED COPY OF 10TH STANDARD MARKS CARD  
 
B
 ATTESTED COPY OF 12TH STANDARD MARKS CARD  
 
C
 ATTESTED COPY OF DEGREE CERTIFICATE/PROVISIONAL DEGREE CERTIFICATE  
 
D.
 ATTESTED COPY OF CHARACTER CERTIFICATE  
 
E.
 ATTESTED COPY OF NO OBJECTION CERTIFICATE/MIGRATION
CERTIFICATE FROM THE UNIVERSITY OF BACHELORS DEGREE STUDY
(For non-Karnataka students only: Can be submitted at the time of admission)		  
 
     

FOR OFFFICE USE ONLY
1.
   MARKS/PERFORMANCE IN WRITTEN TEST/PERSONAL   INTERVIEW  
2.
   ADMISSION FEE RECEIPT NUMBER  
3.
   HOSTEL FEE RECEIPT NUMBER  
4.
   CHECKLIST FOR THE DOCUMENTS    
 
A
 ORIGINAL MARKS CARD OF 10TH STANDARD  
 
B
 ORGINAL MARKS CARD OF 12TH STANDARD  
 
C
 ORGINAL MARKS CARD OF BACHELORS DEGREE  
 
D.
 ORIGINAL BACHELORS DEGREE CERTIFICATE  
 
E.
 ORIGIANL CHARACTER CERTIFICATE  
 
F.
 ORIGINAL NO OBJECTION CERTIFICATE/MIGRATION CERTIFICATE  
 
G.
 ORIGINAL TRANSFER CERTIFICATE FROM THE UNIVERSITY GRANTING THE BACHELORS DEGREE/
FROM THE COLLEGE LAST ATTENDED		  
 
F.
 ORIGINAL NO OBJECTION CERTIFICATE/MIGRATION CERTIFICATE NA    
5.
ADDMISSION TO THE INSTITUTION
GRANTED
KEPT IN WAITING LIST
REJECTED
     
PLACE:    
  DATE:    
     
    SIGNATURE OF THE PRINCIPAL