Application to Post Graduate (PG) Courses 1. Name of the Applicant th (in Block Letters as in 10 grade mark sheet) 2. Gender: Male Female Day Month Year 3. Contact Numbers (Land line with STD Code and Mobile Number) 4. Email ID 5. Place of Birth (City, District, State & Nationality) 6. Passport Number with Validity period (if available) 7. Permanent Address (with PIN code) 8. Address for Correspondence 9. Local Guardian’s Address (Address with Phone Number) 10. Father’s Name Occupation Telephone / Mobile No. Email ID 11. Mother’s Name For office use only Photo A Unit of Sarvodaya Seva Sangha Tick the course applying for: Application No. : Date of Submission: Eligibility for Karnataka Quota : YES NO M.Sc. Psychology M.Sc. Psychological Counseling Date of Birth Transgender (with PIN code) Occupation Telephone / Mobile No. Email ID
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Application to Post Graduate (PG) Courses
1. Name of the Applicant th(in Block Letters as in 10 grade mark sheet)
2.
Gender: Male FemaleDay Month Year
3. Contact Numbers (Land line with STD Code and Mobile Number)
4. Email ID
5. Place of Birth (City, District, State & Nationality)
6. Passport Number with Validity period (if available)
7. Permanent Address (with PIN code)
8.
Address for Correspondence
9.
Local Guardian’s Address (Address with Phone Number)
Any Other specify ..............................................................
17.
Name of theDegree
Max
Scored
1
Max
Scored
2
Max
Scored
3 Max
Scored
4.Language 1 Specify
Max
Scored
5. Language 2 Specify
Max
Scored
Mother Tongue
Cat - II B
Academic Background
a. Details of Qualifying Examinations:
Registration No. Name of the College,Board, University. Overall %of Marks
Year & Month of Passing
SSLC/10th/Equivalent
12th/ PUC/Equivalent
BA/ B.Sc./BA(hons)
Others.........
b. Details of Marks in the Undergraduate Course:
SubjectsMarks Details
TotalAggregatePercentage (%)
Sub - Caste
1Sem /
1Year
2Sem /
2 Year
3Sem /
3Year
Psychology
4Sem /
4Year
5Sem 6Sem
Optional Subjects
20. Application Fee Payment Details
21. Declaration
Payment is made by Cash DD Online
Amount ........................................................Date ..................................Name of the Bank ................................................