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Online Application Form (* All Fields are mandatory)


Instruction :

1. Please fill the complete form correctly.

2. Take a printout after submitting the form.

3. Make a bank draft of Rs. 350(general male candidates)/ 250(ST,SC, OBC & female students) in favor of CIMAGE, payable at Patna brunch.

4. Send us the printout along with the bank draft at : Catalyst College, Behind S.K. Puri Park In-Front of Bank of Baroda Boring Road, Patna. Bihar (India).


APPLICATION FORM FOR SCHOLARSHIP CUM ADMISSION TEST

 
Courses For Application *:
 
1.First Name *: Middle Name: Last Name *:
2.Date Of Birth *: 3.Gender *:
4.Marital Status : 5.Nationality * :
 
6.a) Category * : General SC ST OBC* NRI Company Sponsored
7. Whether Minority : YesNo
8. Religion : Hindu Muslim Christian Sikh Buddhist Jain Others
 
9. Territory : Urban Rural Tribal
10. Employment Status : Employed Unemployed
11.a) Whether a person with disability : YesNo
 
12. Details of Scholarship being received, if any :
a). Annual Scholarship Amount :
b). Scholarship Offered by : Central Govt. State Govt. NGO Others
c). Family Income (yearly) :
d). Please indicate in case of below poverty : YesNo
13. Is hostel facility required ? : YesNo
 
14. Academic Record Minimum Qualification : Under Graduate (UG) courses - Intermediate/ +2; Post Graduation (PG) courses - Graduation
Examination Passed Board/University School/College Year of Passing/Appeared Division Marks(%)
Matriculation *
Intermediate/+2 *
Graduation
Post Graduation
Any Other
 
15. Computer Technical Knowledge : YesNo Typing Speed (In English) : Words per minute
Computer Course Name Duration Institute Year Grade
 
16. Name of the Entrance Examination taken, if any : (Only for the aspirants, who want to apply for PGDM [AIMA] Programme)
Name of the test Registration No. Year Score Percentile
CAT
MAT
Others
 
17. Work Experience if any, Duration
Name of Employer (Please mention latest first) Place Designation From (mm-yyyy) To (mm-yyyy)
1. 
2. 
 
18. Indicate the names of other Colleges/Institues , where you have applied or intend to apply :
1.  2. 
3.  4. 
 
19. Particulars of Parents :
Father's Name * : Mother's Name * :
Occupation * : Occupation :
Mobile No. * : Mobile No. :
 
20. About Gurdian (To be filled only, if other than parents, somebody else acts as a gurdian) :
Name :
Relationship with the candidate : Mobile No. :
Occupation : Annual Income :
 
21. Permanent Address (Do not repeat Student's name/Father's name) :
Address * :
City * : District * :
State * : Pincode * :
 
22. Address for Correspondence (Do not repeat Student's name/Father's name) :
   Check if same as permanent address
Address :
City : District :
State : Pincode :
 
23. Telephone Number (if any) with STD code :
24. Student's Mobile Number * : Mobile No (If have another number).
25. Student's Email Address * :
 
I hereby declare that I have read and understood the conditions of eligibility for the programme for which I seek admission. I fulfil the minimum eligibility criteria and I have provided necessary information in this regard in the application form. I shall provide proof of my eligibility along with the original certificates in the event of qualifying for admission after Entrance Test.I have carefully studied the rules of the College as printed in the prospectus and I accept them and shall not raise any dispute in future over the same rules. In the event of any information being found incorrect or misleading, my candidature shall be liable for cancellation by the College at any time and I shall not be entitled for refund of any fee paid by me to the College.
 
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