Personal 1

Your Name *as mentioned in Secondary School/10th certificate

Gender *

Date of Birth *

Email Address *

Confirm Email Address *

Mobile Number *

Phone No

Nationality *

Domicile State *

Personal 2

Father's Name *

Father's Occupation

Father's Official Address

Father's Phone No

Father's Email

Mother's Name *

Mother's Occupation

Mother's Official Address

Mother's Phone No

Mother's Email

Personal 3

Mailing Address *

City *

PIN Code

Contact No.(s)

Country *

Permanent Address

City (permanent)

PIN Code (permanent)

Education 1

Class 10th Board Name *

Class 10th School Name *

Class 10th Subjects Name *

Class 10th Year of Passing *

Class 10th Marks (in %) / C.G.P.A Secured *

Class 12th Course Name *e.g., Sc, Arts,etc

Class 12th Board/University Name *

Class 12th Institute Name *

Class 12th Subjects Name *

Class 12th Year of Passing *

Class 12th Marks (in %) / C.G.P.A Secured

Education 2

Other Course Name

Other Board/University Name

Other College Name

Other Subjects Name

Other Year of Passing

Other Marks (in %)

Others

Academic Awards/ Medals/ Prizes/ Scholarships/ Honours etc.

Extra-Curricular Activities/ Hobbies *

Please specify

Declaration

I have read the information brochure and agree to follow all the terms and conditions given therein. All entries made in this application form are true to best of my knowledge and belief. I will produce original certificates at the time of interview. My candidature can be cancelled at any stage, if any information given is found to be untrue. I also understand that final decision rest with SSU authorities regarding admission to the program. * Yes

Sri Sri University, Odisha - BBA (2014-17)