Application to Post Graduate (PG) Courses

1. Name of the Applicant th(in Block Letters as in 10 grade mark sheet)

2.

Gender: Male FemaleDay Month Year

3. Contact Numbers (Land line with STD Code and Mobile Number)

4. Email ID

5. Place of Birth (City, District, State & Nationality)

6. Passport Number with Validity period (if available)

7. Permanent Address (with PIN code)

8.

Address for Correspondence

9.

Local Guardian’s Address (Address with Phone Number)

10. Father’s Name

Occupation

Telephone / Mobile No.

Email ID

11. Mother’s Name

For office use only

Photo

A Unit of Sarvodaya Seva Sangha

Tick the course applying for:

Application No. : Date of Submission:

Eligibility for Karnataka Quota : YES NO

M.Sc. Psychology

M.Sc. Psychological Counseling

Date of Birth Transgender

(with PIN code)

Occupation

Telephone / Mobile No.

Email ID

12. Blood Group

13. Religion

14. Caste

15.

16. Reservation Category (Supporting Documents Required)

General

SC

ST

Cat - I

Cat - II A

III A III B

OBC

Any Other specify ..............................................................

17.

Name of theDegree

Max

Scored

1

Max

Scored

2

Max

Scored

3 Max

Scored

4.Language 1 Specify

Max

Scored

5. Language 2 Specify

Max

Scored

Mother Tongue

Cat - II B

Academic Background

a. Details of Qualifying Examinations:

Registration No. Name of the College,Board, University. Overall %of Marks

Year & Month of Passing

SSLC/10th/Equivalent

12th/ PUC/Equivalent

BA/ B.Sc./BA(hons)

Others.........

b. Details of Marks in the Undergraduate Course:

SubjectsMarks Details

TotalAggregatePercentage (%)

Sub - Caste

1Sem /

1Year

2Sem /

2 Year

3Sem /

3Year

Psychology

4Sem /

4Year

5Sem 6Sem

Optional Subjects

20. Application Fee Payment Details

21. Declaration

Payment is made by Cash DD Online

Amount ........................................................Date ..................................Name of the Bank ................................................

Payment Details (DD no/ Ref No/ UTR No. etc) :.................................................................................................................

For cash payment, Cash Receipt No....................................................................................................................................

1) I hereby declare that information mentioned in the application is true to the best of my knowledge.

2) I agree to abide by the rules and regulations of the Institute in force from time to time if admitted.

3) I am aware that my admission is subject to the approval from Bangalore University.

4) I undertake to intimate the Institute immediately if there is / are any change/s in my permanent

address, correspondence address, Email ID, Phone No. with STD code, Mobile No. etc.,

Date:

Place:

Signature of the Applicant

Signature of Parent / Guardian

(Incomplete Application / Application without mandatory enclosures is liable to be rejected)

18. Details of any other PG Degree / Diploma / Certification Course obtained or being obtained

Name, designation and addresses of any two Teachers/Faculty who could be contacted for reference check19.

2. Name .........................................................................

Address ......................................................................

....................................................................................

....................................................................................

Phone No....................................................................

Email ..........................................................................

1. Name .........................................................................

Address ......................................................................

....................................................................................

....................................................................................

Phone No....................................................................

Email ..........................................................................

Details of the timeline of admission process are available on the IIPR website www.iipr.in

Application forms should be filled up neatly in block letters.

Application forms along with supporting documents may be submitted directly (In -Person) between 10 AM and

5 PM on all working days at the office of admissions or could be sent through registered post, courier service at

the below mentioned address -

Office of Admissions, Indian Institute of Psychology and Research(IIPR),

St. Anthony's Friary, # 85, Hosur Road, Bangalore- 560095.

Following enclosures need to be submitted along with the duly filled in application forms.-

1. Application processing fee details are available on the website link:

http://iipr.in/admission_procedure.html

Fee should be paid by Cash/ Online Transfer / Demand Draft (DD drawn in favour of “IIPR”. Name

of the Applicant and Course Applied for should be written behind the DD).

2. Copy of 10th,12th and all semester/ year of B.A / B.Sc. Marks Sheets

3. Conduct certificate from the principal of the college / university department last attended / from a

Gazetted office

4. Copy of Transfer Certificate

5. Copy of Migration Certificate for candidates from outside Bangalore University .

NOTE : Original Documents pertaining to all the above should be submitted at the time of admission along with

5 passport size photographs.

Guidelines for Submission of Application Forms:

Write in about 100 words the reasons for applying for this course. Use the space provided below.22.