to download Eligibility Assessment Form - International Center

Sl.UNIVERSITYOF MYSOREINTERNATIONAL CENTERUniversity of College of Fine Arts Premises, Manasagangotri, Mysore-570 006Passport sizePhotographApplication Form for Eligibility Assessment of Foreign Degrees/Diplomas/Certificates1. Name of the applicant as it appears in themarks transcript (in capitals)2. Place & Date of Birth (as in school records) Place Day Month Year3. Country, State and Place of Residence4. Nationality and Religion5. If you are an NRI/POI/POI Card Holder/OCI,please specify (Attach a copy of certificate)6. Gender (Enter ‘M’ or ‘F’)7. Marital Status8. Mother Tongue9. Name, Occupation & Address of Parent/Guardian/Spouse10. Name and Address of the Institution lastattended11. Highest examination passedExam.Year & MonthResult with Gradeand Percentage(Please provide a copy ofthe Conversion Table)12. Details about previous education No. ofyears(a) Primary School(b) Higher Primary/Middle School(c) High School(d) Higher Secondary/Pre-University(e) Undergraduate(f) Postgraduate13. Local address to which communication isto be sent with Telephone No. and Email ID14. Subjects offered at the qualifying examinationMedium ofInstructionLanguagesstudied

2…15. If you have taken an English Language Course, please provide the following details:Name of the Course Duration Institution offering thecourseTitle obtained aftercompletion of the course16. Courses of study the applicant wishes topursue as a regular student in theUniversity of Mysore17. Passport Number, Date, Place of Issueand Date of Expiry18. Details of application fee and eligibility assessment fee paid(Challan number, date and amount)19. Documents to be enclosed:(a) Photocopy of Marks Card/Transcripts/Marks Statement ofQualifying Examination (English Version)(b) Photocopy of Degree Certificate(c) Photocopy of Passport/Visa(d) Grade Conversion Table/Scheme of Examination/Syllabus(e) Original Challan for having paid the application fee andeligibility assessment fee(f) Any other certificate/information which supports theapplicant’s eligibility.Note:1. Issue of eligibility certificate does not confer right of admission or guarantee a seat, either in theUniversity/College/Department or in any of the affiliated Institutions.2. Issue of eligibility certificate is based on the authenticity of the school/university records/certificates and theadmission is liable to be cancelled at any time during the stay of the applicant in the University, if therecords/certificates are found incorrect.DECLARATION BY THE APPLICANT1. I hereby affirm that I shall always abide by the rules and regulations of the University of Mysore and I shalladhere to the instructions issued by the University from time to time.2. I hereby affirm that I will undergo a medical examination soon after my arrival in India and that the medicalcertificate would be produced at the time of my admission to the College/Department.3. I solemnly declare that the particulars given above are correct and I submit myself to the disciplinaryjurisdiction of the authorities of the University who may be vested with the authority to exercise disciplineunder the Act, the Statutes, the Ordinances and the Rules that have been framed from time to time by theUniversity.Date :Place:Name, Address, Telephone No. and Email IDof the person applying for eligibility*Signature of the applicant* An authorized person can apply for assessment of eligibility on behalf of a candidate seeking admission to theUniversity, subject to production of valid documents as prescribed by the University.