ENTRANCE REGISTRATION FORM

B. Tech., B. Pharm., MBA, MCA Session: 2011 - 2012

1. Select the Course you are applying for (tick the appropriate option) :

B. Tech.

B. Pharm.

MBA

MCA

2. Name of the Candidate (as given in mark-sheet of class X)

3. Fathers Name (as given in mark-sheet of class X)

Affix a recent colored passport size photograph of the candidate

4. Date of Birth (as in class X mark-sheet)

5. Category (SC / ST / OBC / General)

6. Address of the Candidate

7. Profession of Father

8. Contact Details of Father

9. Contact Details of Candidate

10. E-mail ID of Candidate

11. Educational Qualifications (attach photocopy of all mark-sheets and passing certificates along with this form) Class Year School / College Board/University X XII Stream:______________ GRADUATION
(if applying for MBA or MCA)

Percentage

Stream:______________ 12. Entrance Test Fee Details (Rs.500/-) 13. Preferred Test Center and Date

DD No._____________ Dt._____________
(Attach a DD of Rs.500/- in favour of GLA UNIVERSITY payable at VRINDAVAN)

Center_____________ Dt._____________
(There is no guarantee that candidate will be allotted the preferred center and date.)

This form can be submitted either by post or by hand at university campus address. You will be informed about further course of action required within 7 working days of receiving this form. Date:
To be filled by University (Not to be filled by candidate)

(Signature of Candidate)

DD Received (by accounts office)

Data Entry & Response

On(Dt.): Checked: Name: Sign:

ID: HT Created:
Sign of creator:

PSWRD: HT Sent:

(Signature of Admission Coordinator)