CCE-PROFICIENCE

INDIAN INSTITUTE OF SCIENCE, BANGALORE - 560 012

CHECK SHEET
To be filled in by the candidate and submitted with the application form. A tick
the box provided.

should be placed in

1. Application form has been filled up completely with details

2. A Photostat copy of the degree certificate is enclosed
3. Special background / experience relevant to the pre-requisites (for the course(s) applied)
are indicated explicitly
4. Separate application form has been filled in for each course
5. Registration Fee of Rs.250/- and respective Course Fee with each application

Name:
______________________________________________________________________
Address:
_______________________________________________________________________
E-mail:
________________________________________________________________________
Course applied for, in order of preference (separate application form should be submitted for each course)
Prefer
No.

Course
No

Name of the Course

For Office use

Roll No.

Date:
Signature of the Applicant
--------------------------------------------------------------------------------------------------------------------------

CCE-PROFICIENCE
INDIAN INSTITUTE OF SCIENCE,
BANGALORE - 560 012

Acknowledgement
Candidates Name: __________________________

Your application(s) has / have been registered as under

Prefer
No.

Course
No

Name of the Course

For Office use

Roll No.