1. APPLICATION FORM - 2011
Your application for "Stream SX" has now been incorporated into our system and you have been
assigned the Application number 1170966.
1170966
Stream SX
Application No.
1 Name of Candidate (as in 10th Marks Card) : LOKESH JANGIR
2 Date of Birth(dd/mm/yyyy) : 08/08/1994
3 Category : OBC
4 Nationality : Indian
5 Gender : Male
Exam Board Science Maths Physics Chemistry Biology Others Aggregate
6 X Std CBSE 90 90 N/A N/A N/A N/A N/A
(% marks)
7 XII Std CBSE N/A NA NA NA NA NA NA
(% marks)
8 In the academic year 2011-2012 I have joined XII Standard in Science Subjects
9 Centre for writing Aptitude Test (for SA, SB and SX only) : Jaipur
10 Language in which would like to take your Aptitude Test : English
11 Name of College/Institution : MAA BHARTI PUBLIC
SCHOOL,KOTA
12 Address of College/Institution : KOTA
KOTA
RAJASTHAN
VILL-MAKHAR
POST-ISLAMPUR
JHUNJHUNU
Rajasthan
333024 Candidate Signature:
09829202000 09829202000
JANGIRRAVI9@GMAIL.COM
CERTIFIED BY THE COLLEGE/INSTITUTION
Mr. LOKESH JANGIR is a bonafide student of MAA BHARTI PUBLIC SCHOOL,KOTA and his
date of joining XII Standard in Science Subjects is on:
and all the information furnished by the applicant is correct.
Date: Signature of the Head of the Institution
Place: Name:
2. Institution Seal:
However, your application is not complete until you do the following:
1. Take a print out of this Application Form and make sure that it is complete with a application
number and your signature. Please also obtain your School / College Principal’s signature and
seal in the appropriate place. Do not make any changes / alterations to this page.
2. Application Processing Fee: * ** Processing fee for application is Rs. 200/- (Rs. 100/- for
SC/ST candidate) by means of remitting Rs. 200/- (Rs. 100/- for SC/ST candidate)“to
any core banking branches of STATE BANK OF INDIA, payable at all branches in India.
Paid into the credit of "Kishore VaigyanikProtsahanYojana(KVPY) A/c. No.
10270577392" and send the “Pay-In-Slip” (Applicants are instructed to download the “Pay-
In-Slip” from KVPY web site - http://www.kvpy.org.in/) along with the Application, clearly
indicating the stream (SA, SX, SB, SP). Ensure that you also write the Application Number on
the reverse of the Pay-In-Slip as well as other documents that you send along with this
application.
* Girl students are exempted from payment of processing fee.
** Physically and visually challenged students are also exempted from payment of
processing fee.
3. For Stream SX – The student aspiring to join undergraduate program in Basic Sciences for the
session 2012 – 2013.
4. If you have obtained a letter grade in your qualification exam please convert into an appropriate
% and fill-up in the application form.
5. Stream SP (Medicine) – The application must be accompanied by two recommendation letters in
the prescribed forms one form from Teacher / Instructor in your College/University and the
other from the Advisor/Supervisor of your KVPY project (Bio-Medical Project). Each
recommendation letters must be placed in different envelopes, sealed and with signature of the
person giving the recommendation across the sealed envelopes. These sealed envelopes must
accompany with your application.
6. Enclose the following :
o Caste certificate in the case of SC/ST candidate
o Medical certificate from the prescribed authority in case of physically and visually
challenged candidates.
o Project report in the case of SP – Basic Sciences / Medicine
o Original Pay-In-Slip of the Processing fee of Rs. 200/- (Rs. 100/- for SC/ST).
o Attested copies of your marks statement of the qualifying examination(self attestation
is acceptable ) for Stream SP only
7. Send all the above documents so as to reach on or before 12/09/2011 to
The Convener, KVPY
Indian Institute of Science
Bangalore – 560 012.
8. Last date for closing of online application is 9th September 2011 at twelve O’ clock midnight
9. You may check to see that your application is complete and all documents received at the KVPY
office by going to http://www.kvpy.org.in. Please allow at least 20 days after sending your
documents for postal delays for status information.
10. Issue of hall ticket – through KVPY website (for online applicants only for SA, SX, SB):
Website URL: http://www.kvpy.org.in/
Login ID – Application number
Password – Date of Birth
Application No. 1170966
