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Phone Number:*

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Email:*

Parent's Email:

Programs:*

Date of Birth:*

Age:*

Marital Status:*

Gender:*

Category:*

Religion:*

Nationality:*

Father's Name:*

Father's Contact No:*

Father's Email:

Father's Annual Income:*

Father's Job Postion/Organization:

Father's Occupation*

Mother's Name:*

Mother's Contact No:*

Mother's Email:

Mother's Annual Income:*

Mother's Job Postion / Organization:

Mother's Occupation*

Permanent Address Line 1: *

Permanent Address Line 2:

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State: *

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PINCODE: *

Is the Communication Address the same as Permanent Address?

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Address Line 2:

City: *

State: *

Country: *

PINCODE: *

Year of Passing Class 10:*

Name of Board Class 10:*

Percentage Class 10:*

Year of Passing Class 12:*

Name of Board Class 12:*

Major Subject Class 12:*

Percentage Class 12:*

Have you participated in NCC/NSS?*

If yes, give details:

Academic Level:*

Sports or Games:

Cultural Events:

How did you come to know about St. Xavier's Bangalore?*

Explain why you have chosen to study at St. Xavier's Bangalore:*

Do you have any existing medical conditions or concerns?*

Do you have any allergies?*

Any other special health or medical needs:*

Name of Board/ University Degree*

Duration of Degree*

Is it Foreign University*

Address of Foreign University:*

Overall percentage Degree*

Do You Have Any Backlog/Arrears/Supplementary Papers In Your Graduation Course Yet To Be Cleared As On This Day?*

Education - PG Degree Post Graduation*:

Year of Passing - Degree:*

Title of Degree:*

Mode of Learning - Degree:*

Major Subject - Degree:*

Other Recognized Course:

Competitive Exam: *

Photograph:*

Signature:*

* Application Form Fees: Rs.1200 I hereby declare that the particulars given in this application are true and correct and will be supported by original documents when required. I confirm that I have fully read the terms and conditions regarding the admission to The Xaviers MCA program and pursuit of the same including those relating to withdrawal from the programme after admission.

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