GITAM INSTITUTE OF SCIENCE GITAM (DEEMED TO BE UNIVERSITY) (Established u/s 3 of UGC Act, 1956) VISAKHAPATNAM-530045 + Accredited by NAAC with 'A ' Grade" GSAT-2019 APPLICATION FOR ADMISSION TO UG & PG SCIENCE PROGRAMS Note: Read the instructions carefully before filling this form. This sheet should not be mutilated or folded or stapled. Apply separately for each test Program applied Application Number 1. Test Code: Registration Number (For office use only) 2 Name of the test center: 3. Name of the Applicant (in capital letters) Surname Name 4. Name of the Parent/Guardian 5. Date of Birth Day Month Year 9. Particulars of Qualifying Examination (a) Qualifying Examination: _____________ (b) Result Status : Completed / Awaited 10. Particulars of fee paid : DD No. Date : Amount : Bank : STD Code Phone No. Mobile No. Phone Number Email ID : 11. Address for Communication (CAPITAL LETTERS only) 6. Sex Male / Female 8. Reservation Category (if any) SC/ST/PH/Others ( c ) Group Subjects: Subject 1 ________________________ Subject 2 ________________________ Subject 3 ________________________ Address : ............................................................................. ............................................................................................. ............................................................................................. .......................................... Pin: ........................................... Aadhaar No. Signature of the Applicant 7. Nationality : State : Affix Latest Passport size Photograph
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GSAT 2019 Brochuregsat.gitam.edu/images/gsat2019-application.pdf · GSAT- 2019 APPLICATION FOR ADMISSION TO UG & PG SCIENCE PROGRAMS Note: Read the instructions carefully before filling
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GITAM INSTITUTE OF SCIENCE GITAM (DEEMED TO BE UNIVERSITY)
(Established u/s 3 of UGC Act, 1956)
VISAKHAPATNAM-530045+Accredited by NAAC with 'A ' Grade"
GSAT- 2019APPLICATION FOR ADMISSION TO UG & PG SCIENCE PROGRAMS
Note: Read the instructions carefully before filling this form. This sheet should not be mutilated or folded or stapled. Apply separately for each test
Program applied
Application Number
1. Test Code:
Registration Number (For office use only)
2 Name of the test center:
3. Name of the Applicant (in capital letters)
Surname
Name
4. Name of the Parent/Guardian
5. Date of Birth
Day Month Year
9. Particulars of Qualifying Examination
(a) Qualifying Examination: _____________
(b) Result Status : Completed / Awaited
10. Particulars of fee paid : DD No. Date :
Amount : Bank :
STD Code Phone No. Mobile No.
Phone Number
Email ID :
11. Address for Communication (CAPITAL LETTERS only)
*(Tests will be conducted at the above centers depending on the number of candidates opting for those centers. If sufficient number of candidates do not opt for a particular center, they will be allotted to the near by center)
Details of qualifying examinations:
School/College Title of the Degree/ Qualification
Max Marks
Marks Obtained
% CGPA
Year of Passing
X / SSC*
Inter / 10+2*
Undergraduate*
(* Specify Title of the Degree Awarded)
Documents to be enclosed:
th Original Demand Draft Copy of 10 Pass Certificate Copy of 10+2 Pass Certificate
Copy of Degree Marks Statement if available Aadhar Card
I came to know about GIS through
Newspaper TV Alumni EducationFairs Internet Hoardings
Direct Enquiry Counseled by GIS staff Current Student Faculty &Staff
Declaration: I hereby declare that all the particulars stated in this application are true to the best of my
knowledge and belief. In the event of submission of incorrect or untrue information, I understand that my
admission is liable for cancellation. Further I understand that my admission is purely provisional and subject to
the fulfillment of the eligibility conditions. There will be no refund of Application Fee for any reason. I agree to
receive communication through SMS related to admission process. I shall abide by the rules and regulations of
GITAM (DEEMED TO BE UNIVERSITY).
Signature of the applicant with date
SIGNATURE OF PARENT/GUARDIAN
GITAM INSTITUTE OF SCIENCE GITAM (DEEMED TO BE UNIVERSITY)
(Established u/s 3 of UGC Act, 1956)Gandhinagar Campus, Rushikonda, Visakhapatnam-530045, A.P., India
0891-2840450/452 / 2790101, Telefax: 0891 – 2790032, website: www.gitam.edu+Accredited by NAAC with 'A ' Grade"
GITAM INSTITUTE OF SCIENCE GITAM (DEEMED TO BE UNIVERSITY)
(Established u/s 3 of UGC Act, 1956)Gandhinagar Campus, Rushikonda, Visakhapatnam-530045, A.P., India
0891-2840450/452 / 2790101, Telefax: 0891 – 2790032, website: www.gitam.edu+Accredited by NAAC with 'A ' Grade"
DUPLICATE
ORIGINAL
Program :
Test Code :
Test Centre :
Date of Examination
Name of the candidate
(in capital letters) ____________________________________________
Name of the Parent / Guardian ____________________________________________
Signature of the candidate ____________________________________________
Program :
Test Code :
Test Centre :
Date of Examination
Name of the candidate
(in capital letters) ____________________________________________
Name of the Parent / Guardian ____________________________________________
Signature of the candidate ____________________________________________
Hall Ticket No (to be filled in by the office)
Hall Ticket No (to be filled in by the office)
Recent Passport size Photograph
Recent Passport size Photograph
GSAT -2019GITAM Science Admission Test
UG & PG Programmes for the academic year 2019 - 20
HALL TICKET
GSAT -2019GITAM Science Admission Test
UG & PG Programmes for the academic year 2019 - 20