School of Management, KIIT University (KSOM - MBA), Bhubaneswar, India

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Personal 1
Personal 2
Education 1
Education 2
Work Experience
Others
Declaration
Documents

Personal 1

Which Course do you wish to apply? *

First preference for GD & PI centre *

Second preference for GD & PI centre *

Third preference for GD & PI centre *

Fourth preference for GD & PI centre *

Fifth preference for GD & PI centre *

Your Name *

Email *

Date of Birth *

Mobile Number *

Gender *

Marital Status *

Category *

Nationality *

Personal 2

Address *

City *

PIN Code *

Country *

Father's Name *

Father's Occupation

Mother's Name *

Mother's Occupation

In Emergency, We can contact

Emergency Contact Number

Relationship With You ?

Parent's Phone No *

Family Annual Income *

Do you want to avail a study loan for the course? *

Are you physically challenged? *

If physically challenged, kindly provide details

Education 1

Class 10th Board Name *

Class 10th School Name *

Class 10th Year of Passing *

Class 10th Division *

Class 10th Marks (in %) *

Class 12th Course Name *e.g., Sci, Arts, etc.

Class 12th Board/University Name *

Class 12th Institute Name *

Class 12th Year of Passing *

Class 12th Division *

Class 12th Marks (in %) *

Graduation Course Name *e.g., BTech, Bcom, etc.

Graduation University Name *

Graduation College Name *

Graduation Year of Passing *Expected year, if not already graduate

Graduation Division

Graduation Marks (in %)

Education 2

Post Graduation Course Namee.g., MA, Msc, etc.

Post Graduation Board/University Name

Post Graduation College Name

Post Graduation Year of Passing

Post Graduation Division

Post Graduation Marks (in %)

Other Course Name

Other Board/University Name

Other College Name

Other Year of Passing

Other Division

Other Marks (in %)

Work Experience

Name of current organization worked at

Period from which onwards you worked at current organization

Period till which you work at current organization

Designation at current organization

Experience at current organization(including remuneration)

Name of previous organization worked at

Period from which onwards you worked at previous organization

Period till which you worked at previous organization

Designation at previous organization

Experience at previous organization(including remuneration)

Name of other organization worked at

Period from which onwards you worked at other organization

Period till which you worked at other organization

Designation at other organization

Experience at other organization(including remuneration)

Others

Entrance Exam 1 appeared

ID/ Regn No/ Roll No of entrance exam 1

Composite score/ Percentile secured in entrance exam 1

Entrance Exam 2 appeared

ID/ Regn No/ Roll No of entrance exam 2

Composite score/ Percentile secured in entrance exam 2

Entrance Exam 3 appeared

ID/ Regn No/ Roll No of entrance exam 3

Composite score/ Percentile secured in entrance exam 3

Please state briefly, why you have chosen to take up management as a career *(not exceeding 60 words)

If you have represented in any sports at State/National level, give details

Declaration

I certify that the information furnished in this application are true to the best of my knowledge. My application may be rejected and admission shall be cancelled if any information provided herein is found to be incorrect at any time even after admission. * Yes

Documents

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