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Instructions to Fill in the Application Form - Goa University

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<strong>Instructions</strong> <strong>to</strong> <strong>Fill</strong> <strong>in</strong> <strong>the</strong> <strong>Application</strong> <strong>Form</strong><br />

1. Please read <strong>the</strong> application form carefully before fill<strong>in</strong>g. <strong>Fill</strong> <strong>in</strong> <strong>the</strong> form legibly and return it <strong>to</strong> <strong>the</strong><br />

office of <strong>the</strong> Department of Computer Science & Technology, <strong>Goa</strong> <strong>University</strong> on or before Friday<br />

3 rd June, 2011(4.00 pm). Please note that no application will be received after this date and <strong>the</strong><br />

department will not be held responsible for any postal delays<br />

In case <strong>the</strong> application is be<strong>in</strong>g sent by post, send <strong>the</strong> application <strong>to</strong> :<br />

The Admission Coord<strong>in</strong>a<strong>to</strong>r, 2011 - 2012<br />

Department of Computer Science & Technology,<br />

<strong>Goa</strong> <strong>University</strong>, Taleigao Plateau,<br />

<strong>Goa</strong> 403 206.<br />

Phone: (0832) – 6519272/ 6519072 / 6519087<br />

E-mail: dcst@unigoa.ac.<strong>in</strong> / vvkamat@unigoa.ac.<strong>in</strong><br />

2. Do not attach orig<strong>in</strong>al certificates or mark sheets etc., only attested true copies or attested Xerox<br />

copies should be enclosed. Orig<strong>in</strong>al certificates and mark sheets must be brought at <strong>the</strong> time of<br />

admission fail<strong>in</strong>g which no admission will be given.<br />

3. Follow<strong>in</strong>g documents must accompany <strong>the</strong> application form.<br />

1. XIIth Std. marksheet<br />

2. Graduation year one, year two mark sheets<br />

3. Graduation f<strong>in</strong>al year mark sheet, if result is declared<br />

4. Proof of hav<strong>in</strong>g secured a score of at least 50 percentile <strong>in</strong> GA paper <strong>in</strong> <strong>the</strong> CST E-level<br />

or I-level test. The CST score entered <strong>in</strong> <strong>the</strong> application form must be identical <strong>to</strong> <strong>the</strong><br />

score <strong>in</strong> <strong>the</strong> candidate’s CST score card.<br />

5. SC/ST/OBC/PH/FF certificate wherever applicable. (Only for candidates pass<strong>in</strong>g out<br />

from <strong>Goa</strong> <strong>University</strong>)


GOA UNIVERSITY<br />

Department of Computer Science & Technology<br />

MASTERS OF COMPUTER APPLICATIONS<br />

<strong>Application</strong> <strong>Form</strong> (2011 (201 - 2012)<br />

1. NAME _____________________________________________________________<br />

_____________________________________________________________<br />

_____________________________________________________________<br />

(BLOCK LETTERS) (SURNAME) (S<br />

(FIRST NAME) E) (MIDDLE NAME)<br />

2. DATE OF BIRTH: H: _____/______/_________<br />

3. PLACE OF BIRTH: __________________________<br />

4. ADDRESS FOR CORRESPONDENCE:<br />

__________________________________________________<br />

___________________________________________________________________________________<br />

___________________________________________________________________________________<br />

5. PHONE WITH STD/ISD CODE____________________________EMAIL<br />

________________________<br />

6. CATEGORY GENERAL ENERAL SC ST OBC PH<br />

(In case of SC/ST/OBC/PH/FF attach certificate)<br />

7. WHETHER CANDIDATE HAS APPEARED/PASSED APPEARED<br />

____________<br />

DEGREE:<br />

IN FINAL YEAR OF DEGREE PROGRAM<br />

______________<br />

PASSED YEAR:<br />

8. NAME AND ADDRESS OF THE COLLEGE FROM WHICH THE BACHELOR’S DEGREE IS<br />

OBTAINED<br />

______________________________________________________________________________________<br />

______________________________________________________________________________________<br />

9. EDUCATIONAL QUALIFICATION (Beg<strong>in</strong>n<strong>in</strong>g with S.S.C. Exam<strong>in</strong>ation or Equivalent)<br />

Certificate/Degree<br />

Board/<strong>University</strong> Month &<br />

Year<br />

of Pass<strong>in</strong>g<br />

* GRADUATED FROM G O F<br />

FF<br />

Percentage<br />

Obta<strong>in</strong>ed<br />

Paste your<br />

Passport size<br />

Pho<strong>to</strong>graph<br />

Class<br />

awarded


10. CST SCORE DETAILS<br />

ROLL NUMBER ______________________ DATE OF CST EXAMINATION<br />

_______/______/__________<br />

Part A : General aptitude<br />

Paper Raw Score Score Percentile Candidates<br />

* CATEGORY G - If graduated from <strong>Goa</strong> <strong>University</strong> O - If graduated from o<strong>the</strong>r<br />

Indian Universities<br />

F - Foreign Student<br />

11. DEMAND DRAFT DETAILS :<br />

Name of Bank Branch from where<br />

D.D. Drawn<br />

DECLARATION BY THE APPLICANT<br />

D.D. Number Date when<br />

drawn<br />

Amount<br />

I hereby declare that <strong>the</strong> particulars furnished by me <strong>in</strong> this application are correct <strong>to</strong> <strong>the</strong><br />

best of my knowledge. If any <strong>in</strong>formation is found <strong>to</strong> be false/<strong>in</strong>correct at any time or if I am unable<br />

<strong>to</strong> furnish documentary proof of my qualify<strong>in</strong>g degree and percentage of marks at <strong>the</strong> time of<br />

admission, I am liable <strong>to</strong> be disqualified.<br />

DATE : ____/____/________<br />

PLACE : _________________<br />

Signature of <strong>the</strong> Applicant<br />

Important: Last date for <strong>the</strong> receipt of duly filled <strong>in</strong> <strong>Application</strong> <strong>Form</strong> at Department of Computer<br />

Science & Technology, <strong>Goa</strong> <strong>University</strong>: 3 rd June, 2011 (4.00 p.m)


____________________________________________________________________________________<br />

ACKNOWLEDGEMENT SLIP<br />

Received from Shri/Smt ……………………………………………………………………………. ………..<br />

<strong>Application</strong> for admission <strong>to</strong> <strong>the</strong> First Year of <strong>the</strong> M.C.A Course at DCST, <strong>Goa</strong> <strong>University</strong> for Academic<br />

Year 2011-2012 on …………………………<br />

By Post/Hand delivery.<br />

Date: Admission Coord<strong>in</strong>a<strong>to</strong>r 2011-2012<br />

DCST, <strong>Goa</strong> <strong>University</strong>

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