APPLICATION FORM - 2009

Your application for "Stream SA" has now been incorporated into our system and you have been assigned the Application number 833869.



Stream SA Application No. 833869

1 Name of Candidate (as in 10th Marks Card) : Karia Swati Jeetendrakumar
2 Date of Birth (dd/mm/yyyy) : 25/10/1993
3 Category : General
4 Nationality : Indian
5 Gender : Female
Exam Board Science Maths Physics Chemistry Biology Others Aggregate
6 X Std
(% marks) Gujarat 97 98 N/A N/A N/A N/A N/A
7 UG Programme in Basic Sciences (SB only) : NA
8 In the academic year 2009-2010:
SA: I have joined XI Standard in Science Subjects


9 Centre for writing Aptitude Test (for SA, SB and SB+2 only) : Vadodara

10 Name of College/Institution : P,V.Modi Highschool-Rajkot
11 Address of College/Institution : Nr. Virani Highschool Tagore Road, Nr. Revenyu Society,Parijat Building ,Rajkot
BAJARANG, Bedipara
Opp-Delux Cinema chowk
Rajkot
Rajkot-360003
Gujarat
360003
9825627391
hindochaashok@gmail.com

Candidate Signature:






CERTIFIED BY THE COLLEGE/INSTITUTION

Mr./Ms Karia Swati Jeetendrakumar is a bonafide student of P,V.Modi Highschool-Rajkot and his/her date of joining to
a. XI / XII Standard in Science Subject is on (indicate the standard):
b. I/II Yr. B.Sc / M.Sc (Int.) / I/II Yr. MS (Int.) / I/II Yr. Engg/Medicine is on:
and the information furnished by the applicant is correct.






Date:

Place:


Signature of the Head of the Institution

Name:

Institution Seal:




However, your application is not complete until you do the following:

Take a print out of this Application Form and make sure that it is complete with a number and your (candidate) signature. Please also obtain certificate from your School / College Principal’s signature and seal in the appropriate place. Do not make any changes / alterations to this page.
Application Fee: Processing fee for application is Rs. 200/- (Rs. 100/- for SC/ST) by means of remitting Rs. 200 (Rs. 100/- for SC/ST) “to any core banking branches of STATE BANK OF INDIA, payable at all branches in India. Paid into the credit of Administrative Executive, KVPY A/c. No. 10270577392” and send the “pay-in-slip”.
Applicants are instructed to download the “pay-in-slip” in from:
http://www.surfzone.co.in/kvpy-0910/downloads/pay-in-slip.pdf (pdf format)
or
http://www.surfzone.co.in/kvpy-0910/downloads/pay-in-slip.doc (doc format)
along with the Application, clearly indicating the stream (SA, SB+2(SX), SB, SP). Ensure that you write the Application Number on the reverse of the Pay-In-Slip as well as other documents that you send along with this application.
For Stream SB+2 (SX) – The student aspiring to join undergraduate program in Basic Sciences for the session 2010 – 2011.
Stream SP (Medicine) – The application must be accompanied by two recommendation letters in the prescribed forms one form from Teacher / Instructor in your College/University and the other from the Advisor/Supervisor of your KVPY project (Bio-Medical Project). Each recommendation letters must be placed in different envelopes, sealed and with signature of the person giving the recommendation across the sealed envelopes. These sealed envelopes must accompany with your application.
Enclose the following :
Caste certificate in the case of SC/ST candidate
Project report in the case of SP – Basic Sciences / Engineering / Medicine
Original Pay-In-Slip of the Processing fee of Rs. 200/- (Rs. 100/- for SC/ST).
Attested copies of your marks statement of the qualifying examination(self attestation is acceptable )
Send all the above documents to
The Convener, KVPY
Indian Institute of Science
Bangalore – 560 012
on or before 11/09/09
You may check to see that your application is complete and all documents received at the KVPY office by going to http://www.surfzone.co.in/kvpy-0910/appstatus. Please allow at least 20 days after sending your documents for postal delays.
Issue of hall ticket – through KVPY website (for online applicants only for SA, SB+2(SX), SB): Website URL: http://www.iisc.ernet.in/kvpy
Login ID – Application number
Password – Date of Birth