Online Application Form
The ICFAI University, Raipur
Campus-based Programs 2017

Admissions Officer :
The ICFAI Univeresity,Raipur
Campus Address
NH-6, Raipur - Bhilai Road,
KM Stone 20 PO: Kumhari,
Dist: Durg - 490042, Chhattisgarh.
Toll-free: 1800 425 0767
E-mail: ugpgadmissions@iuraipur.edu.in
Website: www.iuraipur.edu.in

 

   1. PLEASE SELECT THE PROGRAM YOU WISH TO ENROLL
 
 
   2. NAME OF THE CANDIDATE (use Capitals Only) [As it appears in the School certificates]

Prefix

:

Please upload your recent color Photograph (JPG / GIF format only)
(size 3.5 cm X 4.5 cm) 

(File size not more than
25-30 KB)

Name

:

   

(As it appears in the School Certificates)

 
   3. PERSONAL DETAILS (use capitals only)
 

Date of Birth

:

Blood Group

:

Mobile

:

E-mail

:

Tel (Res)

:

STD Code

Number 

Nationality

:

Mailing/Postal Address

:

City

:

State/UT

:

Pin

:

Permanent Address

:

City

:

State/UT

:

Pin

:

 
   4. ACADEMIC RECORD: SCHOOL/ COLLEGE

a.

Class

Name of the School/College

City

Board */ University

Group**

Medium of Instruction

Year of Passing

% of Marks

X

XII

Graduation

Others

* Indicate State Board/CBSE/ICSE etc.,
** Indicate PCM/Accounts/Commerce etc or Degree or branch of Diploma as applicable
.

b.

Name & Address of Institute last attended

:

 

City

:

State/UT

:

Pin

:

 
   5. LANGUAGE PROFICIENCY

Please list languages.
The medium of instruction is English. All students are expected to have proficiency in speaking and writing good English.

Languages

Writing

Reading

Speaking

English

Other Languages


(Mother Tongue)

 
    6. DOMICILE STATUS
 
Domicile of Raipur*          Non - Domicile
 
* If you are a Domicile student of Raipur, Please provide the Certificate at the time of Interview
   7. TEST SCORES
 
Test
Score
Rank
Application No
JEE (Main) 2017
CGPET 2017
 
   8. AWARDS AND RECOGNITIONS IN ACADEMICS AND SPORTS

List awards, distinctions, honors and scholarships (academic, extracurricular, community services, etc).

Awards

Year

Basis

 
   9. SOURCE OF CONTACT (Please select or mention how you came to know about ICFAI)
 
Search Engine (Google/Yahoo/Bing/Others)        Website        Social Media (Facebook/Twitter/Other)

New Paper Article         Newspaper/Magazine advertisements       Electronic Media (FM/TV)     
        
Education Fairs       Friends          Events of IUR       Alumni/Students of IUR         Teachers   
   

Others       
 
   10. WHY DO YOU WANT TO JOIN THE PROGRAM AT IUR? Describe briefly
 

Quality of Program       Fee Structure        Nearest to your Location

       Others
       

 
 
   11. FAMILY BACKGROUND
 

a.

No. of Brothers :

No. of Sisters :

        

b.

Did any of them studied at IUR or any ICFAI Institute:
Yes No

 

Name of the Institute

 

Year of Passing

 

Course Completed

b. Parents Info

Father

Name

Qualifications

Occupation

Please Specify  :

Designation

Annual Salary/
Income

Organization
& Address

City

Pin

Ph (O)

STD Code

Number 

Mobile

Personal
E-mail

Company Website

 

Mother

Name

Qualifications

Occupation

Please Specify  :

Designation

Annual Salary/
Income

Organization
& Address

City

Pin

Ph (O)

STD Code

Number 

Mobile

Personal
E-mail

Company Website

 
   12. HOW DO YOU PLAN TO FINANCE YOUR EDUCATION?
 
Parents Support       Bank Loans      Others       
 
   13 . MODE OF PAYMENT
 
Payment Mode
:
 
   14. DECLARATION
 

We hereby declare that the above mentioned information is true to the best of our knowledge and belief.

 
  I Agree