2. Certified copy of the mark sheet/grade sheet/transcripts (front and back sides) of the qualifying examination (10+2 o
Application for International Admissions (UG) ATTACH A RECENT FULL-FACE, COLOUR PHOTOGRAPH HERE
Course: BSc Health Sciences
4.5 cms x 3.5 cms
(TO BE FILLED IN BLOCK LETTERS)
Completed application form along with necessary documents and application fee should be sent to: OFFICE OF INTERNATIONAL ADMISSIONS, MANIPAL UNIVERSITY, MANIPAL 576104, INDIA. For additional information, kindly email to
[email protected] /
[email protected]
GENERAL INFORMATION: NAME: Last
Middle
First
Sex
DATE OF BIRTH Day
Month
Male
Female
Transgender
Year
PLACE OF BIRTH City
State
Country
COUNTRY OF CITIZENSHIP
NAME OF THE PARENT/GUARDIAN
CURRENT POSTAL/ CORRESPONDENCE ADDRESS: (Complete address in block letters)
PARENTS / GUARDIAN
PERMANENT ADDRESS: (Complete address in block letters)
TELEPHONE NUMBER OF PARENT/GUARDIAN (with area code)
Home
Office/Work
EMAIL (in block letters) Parent/Guardian
Student
Manipal University, Madhav Nagar, Manipal 576104, India - Application for Admissions 2017
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ACADEMIC RECORDS Name of the School (10th grade/equivalent): Name of the School (12th grade/equivalent): Qualifying examinations: e.g CBSE, ICSE, HSC, A levels, IB, STPM, OSSD, NCEA Level 3, High School Diploma etc: Examination: ………………………………
Board: …………………………… Year of passing: ………
Subjects
Subjects*
Marks/Grade
Marks%/Grade
Physics
…………………..
……………………
……………………..
Chemistry
…………………..
……………………
……………………..
Biology
…………………..
……………………
……………………..
Mathematics
…………………..
……………………
……………………..
English
…………………..
……………………
……………………..
DECLARATION I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. I have read and understood all provisions of admissions and agree to abide by them. In the event of submission of fraudulent, incorrect or untrue information or suppression or distortion of any fact like education qualification, marks, nationality, etc., I understand that my admission/degree is liable for cancellation. I further understand that my admission is purely provisional subject to the verification of the eligibility conditions. I am also aware of the financial obligation of applying to and studying at this institution and I undertake to pay the tuition and other fee and to abide by all rules and regulations of the institution.
Signature of the applicant:………………………………………………..………..
Date: ……………………….
Signature of parent/guardian: ………………………………………………………… Date: ……………………. DOCUMENTS TO BE ENCLOSED (Photocopy) 1. Application fee of ` 2500 in the form of a bank draft in favour of ‘Manipal Academy of Higher Education’ payable at Manipal or Udupi. 2. Certified copy of the mark sheet/grade sheet/transcripts (front and back sides) of the qualifying examination (10+2 of India or equivalent examination). If the marks sheet/grade sheet is in native language, then Certified English translated version must be submitted. 3. Birth certificate or X Standard mark sheet showing date of birth 4. Copy of the passport of the applicant (personal detail pages only) if available 5. Copy of the passport of parents or guardian, if foreign citizen /NRI. 6. Proof of NRI status of the student/parents/guardian (for NRI students only)
Manipal University, Madhav Nagar, Manipal 576104, India - Application for Admissions 2017
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