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Online Application Form for Scholarship Cum Admission Test

Instruction : - (* All fields are mandatory)
  • 1. Please fill the complete form correctly.
  • 2. Take a printout after submitting the form.
  • 3. Make a bank draft of Rs. 350/- ( General Male Candidate ) / Rs. 250/- ( ST, SC, OBC & Female Students ) in favor of CIMAGE, Payable at Patna Branch.
  • 4. Send us the printout along with the bank draft at : Catalyst College, Behind S.K. Puri Park, In-front of Bank of Baroda, Boring Road, Patna.
Courses for Application *
1. First name *
Middle name
Last name *
2. Date of Birth *
3. Gender *
4. Marital Status 5. Nationality *
6. Category *
In case of OBC Students, Indicate the Layer *
7. Whether Minority
8. Religion
9. Territory 10. Employment Status
11. Whether a person with disability
Types of Disability
12. Details of Scholarship being received, if any : -
a). Annual Scholarship Amount
b). Scholarship offered by
c). Family Income ( Yearly )
d). Please indicate in case of below poverty
13. Is hostel facility required ?
14. Academic Record Minimum Qualification : Under Graduate( UG ) Courses - Intermediate / +2, Post Graduation ( PG ) Courses - Graduation : -
Examination Passed Board / University School / College Year of
Passing / Appeared		 Division Marks (%)
Matriculation *
Intermediate / +2 *
Graduation
Post Graduation
Any Other
15. Computer Technical Knowledge Typing Speed ( In English )
Word per minute
Computer Course Name Duration Institute Year Grade
16. Name of the Entrance Examination taken, if any ( Only for the aspirants, who wants to apply for PGDM [ AIMA ] Programme ) : -
Name of the Test Registration No. Year Score Percentile
CAT
MAT
Others
17. Work Experience if any : - Duration
Name of Employer ( Please mention latest first ) Place Designation From To
18. Indicate the names of other Colleges / Institute, where you have applied or intend to apply : -
19. Particulars of parents : -
Father's Name *
Mother's Name *
Occupation *
Mobile No. *
20. About Guardian ( To be filled only, if other than parents, somebody else acts as a guardian ) : -
Name
Mobile No.
Relationship
Occupation
Annual Income
21. Permanent Address ( Do not repeat Student's name / Father's name ) : -
Address *
City *
State *
District *
Pincode *
22. Address for Correspondence ( Do not repeat Student's name / Father's name ) : -
Address
City
State
District
Pincode
23. Telephone No. ( if any ) with STD Code
24. Student Mobile No. *
Mobile No. ( If have another no. )
25. Student Email Address *
* I hereby declare that I have read and understood the conditions of eligibility for the programme for which I seek admission. I fulfil the minimum eligibility criteria and I have provided ncessary information in this regard in the application form. I shall provide proof of my eligibility along with the original certificates in the event of qualifying for admission after Entrance Test. I have carefully studied the rules of the college as printed in the prospectus and I accept them and shall not raise any dispute in the future over the same rules. In the event of any information being found incorrect or misleading, my candidature shall be liable for cancellation by the College at any time and I shall not be entitled for refund of any fee paid by me to the college.

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