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

Modular Training Programme (MTP)

Application Form I Personal Details
Name: Fathers /Guardians /Spouses Name : Date of birth: Correspondence address (term time address):

Sex: Male / Female Permanent address:

PIN E-mail:

Tel No:

PIN:

Tel No:

2 Department / Centre: Course Date: From:

Sl.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
Form 67 Ver: 2

Signature
Date:24-03-2011 1

RULES & REGULATIONS

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