APPLICATION FORM

Aegis Graham Bell Scholarship (2012-2013)

Please read the following instructions carefully before completing the Application Form.

Filled application form includes the following:

o Basic Information

o Bachelors and / or Masters qualifications

Required Documents Please provide the following documents duly filled and completed in support of your application. Initially send the scanned documents through email. Also send the hard copy of the documents to the Career Management Centre through post.

Copy/ies of Degree (UG/PG) Certificates

Copy of GMAT or CAT test scores (if available) Two passport size photographs (Please staple to your Application Form where indicated OR enclose a scanned copy) A copy of your resume Please check you have included all the necessary attachments to ensure that your Application Form is complete. The admission committee will not consider incomplete Applications. All completed Applications should be sent to the Career Management Centre at Mumbai. For any query and correspondence, please contact.

Career Management Centre Aegis School of Business & Telecommunication Mahesh, Plot No.37, Sector 15, CBD, Belapur New Mumbai- 400614 Maharashtra (India) Phone: +91 022 32185553/31900011 Mobile: +91 (0)9819008153 Email: scholarship@aegis.edu.in Web: www.aegis.edu.in

Name Email id(s) Sex

VIJAY KUMAR VJYKMR135@GMAIL.COM YE

Male 03/08 /90 Female Please Insert PHOTO

Date of birth: Place of Birth City/State/Country Nationality

INDIA
Country of Residence

INDIAN

INDIA

*Passport Number:
*Mandatory for foreign nationals

Current mailing address

S/O- ASHOK RAM AT- MAHANTHNAGAR NEAR TOWER, BARMASIA P.O + DISTT- KATIHAR PIN CODE-854105 YE
Check here if same as current

Permanent mailing address Permanent Address

S/O- ASHOK RAM AT- MAHANTHNAGAR NEAR TOWER, BARMASIA P.O + DISTT- KATIHAR

Current Tel No. Mobile Phone No.

+91-9041564419 +91-9470888397

Permanent Phone No.

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Masters and/or Bachelors Qualifications

Dates From - To (mm/yyyymm/yyyy) FullTime or PartTime Name of Institution Attended (State/ Country) Qualification (Degree) Results (Class/%/ GPA) Specialization (If Any)

08/200907/2013

FULL TIME

LOVELY PROFESSIONAL UNIVERSITY PHAGWARA PUNJAB INDIA

BACHELOR 8.78 CGPA OF TILL VI TECHNOLOGY SEMESTER (B.TECH)

ELECTRONICS AND COMMUNICATIONS

(3)

Test Scores (If any)

Test GMAT (Code: 5730) TOEFL (Code: 5730) CAT GRE (Code: 5730) BATE MAT GATE XAT

Score

Date

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