Online Application Form


Course Applied For :


User Name
University Registration No.
Date of Registration

Personal Details

Name :



Image :


Category :

                                       

Date of Birth :

Nationality :

Indian          Other

Mobile No. :

Sex :

         

Blood Group :

Marital Status :

         

Mailing Address :

Present

Permanent             Same as present address

Email-Id :

Are You Employed? :

            If yes, since when:



Academic details - (Please enclose attested photocopies)

Exam Passed Year of Passing School/College Board/University Subjects Percentage of Marks obtained

Weightages claimed

Participation in Sports-National Level/ State Level/ Inter University or Training Certificate from SAI (Sports Authority of India)
Graduate from CCS University/Other University Honours Degree
Spouse/Son/Daughter of permanent employee of CCS University or its affiliation college
Rover Rangers
Any other weightage information

Family Details

Father's Name :



Father's Details :

            If service, then designation:


Mother's Name :



Local Gaurdian Details :



Family Income :

General Details

Hostel accommodation required :

     

Transport facility required :

     

Scholarship required :

     

Achievements :

Please give two refrences :



Contact Us

IIEM Hapur
Knowledege Park,
Jarothi Garh road, Hapur,
Uttar Pradesh-245101
Phone:+919219402813
Email: info@iiemcollege.com