Xavier Institute of Social Service

Dr. Camil Bulcke Path (Purulia Road) , Ranchi, Jharkhand-834001

Phone : 0651-2200873 | Fax : 0651-2315381

Post Graduate Certificate in Management Geospatial Technology Applications in Rural Development

Admission Form

(Pay before filling the form)

Payment Id : *

Payment Date : *

Applying as : *

Student

Working Professionals

Mention Your Batch Preference *
Shift I (11:30AM to 4:30PM)	Shift II (3:00PM to 6:00PM)

Name : *

Father's Name : *

Mother's Name : *

Mobile : *

Email : *

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Date of Birth : *

Sex : *

Male

Female

Permanent Address

State : *

Pin : *

Phone No. :

Current Address

(if different from permanent address)

Current Address

State :

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Phone No. :

Educational Qualification

SL	Examination	Subject	Institution / Board	Year of Passing	Total Marks	Marks Obtained	Grade / %	Upload Marksheet	Upload Certificate
1	Matriculation *
2	Higher Secondary *
3	Graduation *
4	Post Graduation
5	Any Other
6	Any Other
7	Any Other

Note:- Upload Document in JPG/JPEG/PNG of size between 100 KB and 200kB

Mandatory for working professionals : *

Work Experience Details

(The selection of working Professionals will be on the basis of work experience besides minimum qualification)

SL	Job Title / Job Profile	Organisation / Company Name	From Date	To Date	Duration in Months	Experienece Certificate
1						pdf only
2						pdf only
3						pdf only

Note:- Upload Document in pdf of max size : 100 KB

DECLARATION : *

The above furnished information are authentic, and if they are found to be incorrect at any stage , my candidature will be cancelled and my fees will be forfeited and i will not claim for reimbursement.

Date: *

Place: *

Signature of Candidate in Full *

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