Application for International Admissions

(TO BE FILLED IN BLOCK LETTERS)

Completed application form along with necessary documents and application fee of US$ 50 or ` 2500 in favour of Manipal University should be sent to: OFFICE OF INTERNATIONAL ADMISSIONS, MANIPAL UNIVERSITY, MANIPAL 576 104, INDIA. For additional information, kindly email to foradmission@manipal.edu Category
Please tick the appropriate box in the order of preference MBBS
ATTACH A RECENT
4.5 cms x 3.5 cms FULL-FACE, COLOUR PHOTOGRAPH HERE

Foreign

NRI

NRI Sponsored

BHM BA in Culinary Arts BBM e-Banking & Finance Professional Bachelor of Architecture B Arch B Arch in Interior Design Financial Markets

BDS B Pharm Pharm D BPT/BOT/BASLP/BSc RT/BSc MLT/ BScNMT/BSc HIA/BSc MIT/BSc Opt/ BSc CVT/BSc MRT/BSc RRT & DT BSc Nursing PB BSc Nursing BSc Biotechnology BA Journalism & Communication BBA Jewellery Management

B Tech: (in order of preference) Aeronautical/Automobile/ Biomedical/Biotechnology/ Chemical/ Civil/ Computer Science/ E & C/ E & E/ Industrial Production / Information Technology/ Instrumentation & Control/ Mechanical/ Mechatronics/ Printing Technology

1_______________
2_______________ 3_______________ 4_______________ 5________________

General Information:
NAME:
Last DATE OF BIRTH Day PLACE OF BIRTH City COUNTRY OF CITIZENSHIP NAME OF THE PARENT IF SPONSORED, NAME OF THE SPONSORER Relationship State Country Month Year Middle First

Sex

Male

Female

CURRENT POSTAL/CORRESPONDENCE ADDRESS:

(Complete address in block letters)

FOREIGN ADDRESS (

PARENTS/

SPONSORER)

(Complete address in block letters)

TELEPHONE NUMBER OF PARENT

(with area code)

Home EMAIL (in block letters) Parent Application for Manipal University Admissions 2012 Student Page 1 Office/Work

Academic Records
Qualifying examinations: e.g CBSE, ICSE, A levels, IB, STPM, OSSD, NCEA Level 3 or high school and college grades: Examination: Subjects Physics Chemistry Biology Mathematics English Marks%/Grade .. .. .. .. .. Year of passing: Subjects* Marks/Grade .. .. .. .. ..

*For BAJC, BHM, BBAJM, BBM courses, kindly fill in the qualifying examination marks of all the subjects taken.

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 payable to the institution 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) 2) 3) 4) 5) 6) 7) Application fee of US $ 50 or Indian ` 2500 in the form of a bank draft/cashiers check in favour of Manipal University'. If paid in Indian rupees, then the draft should be payable at Manipal or Udupi. Certified copy (English translated) of the marks/ grade sheet/transcript of the qualifying examination Birth certificate or examination certificate showing date of birth. Copy of passport of the applicant (personal details page) - mandatory for Foreign/NRI students. Copy of the passport of the sponsorer, if sponsored by parents /NRI relative Proof of NRI status of student/parents(for NRI students only) Passport size photograph (recent). One full size photograph for those who apply for Hotel Management course (BHM).

Manipal.edu, Madhav Nagar, Manipal 576 104, India

Application for Manipal University Admissions 2012

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