Admissions to 5 year BS-MS Degree Programme 2017

Admission Form

Please tick appropriate boxes

1. Application Number:
Paste your recent
2. Stream: KVPY JEE Advanced SCB
Passport size
3. Category: GE OBC-NCL SC ST KM Photograph here
4. PD: YES NO
5. Applicants Name:
6. Date of Birth (DD/MM/YYYY):
7. Parents/Guardians Name:
8. Address for Communication Residence Phone:

Mobile:

Email:

9. a) I hereby declare that the particulars stated above are true and based on verifiable records.
b) I undertake to present the original documents immediately upon demand by IISER(s).
c) In the event of suppression or distortion of any fact, I understand that my admission/ degree
acquired is liable for cancellation. I understand that even if I get admitted to IISERs, it does not
necessarily entitle me for a fellowship.
d) I also understand that the decision of the IISER Joint Admission Committee regarding my admission
to IISER, Berhampur/Bhopal / Kolkata / Mohali / Pune / Thiruvananthapuram/ Tirupati is final and I
shall abide by the rules, norms and discipline of the IISER where I join.

Signature of the Candidate Signature of the Parent / Guardian

Place
Date
Enclosures
All relevant documents as asked for in the offer letter