M.S.
RAMAIAH SCHOOL OF ADVANCED STUDIES
No. 470-P, Peenya Industrial Area, 4th Phase, Bengaluru-560 058 Phone: 080 4906 5555, Fax: 080 4211 1205 Web: www.msrsas.org
Affix Photograph
I Personal Details
Name:
Modular Training Programme (MTP)
Application Form
Sex: Male / Female Permanent address:
Fathers /Guardians /Spouses Name : Date of birth: Correspondence address (term time address):
PIN E-mail:
Tel No:
PIN:
Tel No:
Course Date: From: 2 Department / Centre:
S.No 1 2 3 4 Module Title
To:
Remarks
3 Academic Qualifications
Degree Branch Educational Institution School/College/University Year of Passing % of Marks
4 Work Experience (If any)
Duration (months) Company and job title Brief description of work Part-time/ Full-time
Sponsored through company? 5 Payment Details
Amount DD No. Rs. Date: Bank
Date
Signature
Form 67
Ver: 2
Date:24-03-2011
RL S RGL T N UE & E UAI S O
Please read the following carefully:
Fees should be paid on or before the due date, failing which the student will not be allowed to attend the classes. Fees, once paid, will NOT be refunded, under ANY circumstances. On completion of the course, student is required to produce No-due certificate in the prescribed form for obtaining the Course Certificate. Entry to the School premises will be denied if the ID card is not appropriately displayed. The students can use the Students Lounge for discussions but loud discussions should be avoided to maintain the discipline in the School. Students are required to co-operate in maintaining the cleanliness in the School. Smoking, chewing of tobacco, gum or pan is strictly prohibited in the School premises. INTERNET and Library facility will not be available to the MTP students. Misbehavior with any Staff or other students of the School or involvement in any undue argument or discussion with the staff will be viewed seriously. Disciplinary action may be initiated against such students.
I have read and understood the rules and regulations and promise to abide by the same.
Name: ___________________________________ Signature: ________________________________ Date: __________
For office Use
Student joined the course .. in . Centre Student discontinued Student completed the course Remarks:
Form 67
Ver: 2
Date:24-03-2011