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 :


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