I.M.COM. Admission Form


( * ) Mandatory/Compulsory Fields


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Part "A"
Personal Information

Please enter your Surname name Please enter only capital letters/alphabets Surname cannot be longer than 50 digits
Please enter your name Please enter only capital letters/alphabets Name cannot be longer than 50 digits
Please enter Your Fathers's Name/Second Name Please enter only capital letters/alphabets Fathers's Name/Second Name cannot be longer than 50 digits

Please enter Your Full Name Please enter only capital letters/alphabets Full Name cannot be longer than 100 digits


Please enter Your Age Please enter only digits Age cannot be longer than 2 digits

Please enter Your Place of Birth Please enter only alphabets Birth place cannot be longer than 100 characters

   

   
Please tick one





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Please enter Your address


Please enter Your State Please enter valid State

Please enter Your Taluka Please enter valid Taluka

Please enter Your City

Please enter Your Pin code Please enter only digits Pincode cannot be more than 6 digits Pincode cannot be less than 6 digits


Same As Local Address
Please enter Your address


Please enter Your State Please enter valid State

Please enter Your Taluka Please enter valid Taluka

Please enter Your City

Please enter Your Pin code Please enter only digits Pincode cannot be more than 6 digits Pincode cannot be less than 6 digits

(Provide your or your family member's number at which you can be contacted)
Please enter Your mobile Number Please enter only digits Mobile Number cannot be Greater than 10 digits Mobile Number cannot be Lesser than 10 digits
Please enter Your Alternate Contact Number Please enter only digits Number cannot be Greater than 11 digits Mobile Number cannot be Lesser than 10 digits
Invalid Aadhaar Number cannot be Greater than 12 character Aadhaar Number cannot be Lesser than 12 character
(AADHAAR number will be required for further procedures with Goa University. If you do not have it, kindly provide immediately after admission.)

(Enter lower case)

(This email ID will be used by Goa University to confirm your admission and allot University enrollment number. You are required to remember the username and password of this email for further procedures.)






Part "B"
Academic Record

Please enter Name of Institute Please enter only alphabets
Please enter Place of Institute Please enter only alphabets

Please enter Board Name Please enter only alphabets


Please enter Seat No. Please enter only digits

Please enter number of attempts Please enter only digits & attempt cannot be less than 1 Cannot be more than 1 digit

Please enter Marks Obtained Please enter only digits
Please enter Out of Marks Please enter only digits
Please enter your percentage Please enter only digits




Please enter Name of Institute Please enter only alphabets
Please enter Place of Institute Please enter only alphabets

Please enter Board Name Please enter only alphabets


*
Please enter Seat No. Please enter only digits

*
Please enter number of attempts Please enter only digits & attempt cannot be less than 1 Cannot be more than 1 digit

*
Please enter Marks Obtained Please enter only digits
Please enter Out of Marks Please enter only digits
Please enter your percentage Please enter only digits


Please enter Name of Institute Please enter only alphabets
Please enter Place of Institute Please enter only alphabets

Please enter Board Name Please enter only alphabets


*
Please enter Seat No. Name Please enter only digits

*
Please enter your no of attempts Sem I Invalid
Please enter your no of attempts Sem II Invalid

*
Please enter Marks Obtained Please enter only digits
Please enter Out of Marks Please enter only digits
Please enter your percentage Please enter only digits
Please enter sem 1 letter grade Invalid Grade!
   
*
Please enter Marks Obtained Please enter only digits
Please enter Out of Marks Please enter only digits
Please enter your percentage Please enter only digits
Please enter sem 2 letter grade Invalid Grade!
   

Please enter Name of Institute Please enter only alphabets
Please enter Place of Institute Please enter only alphabets

Please enter Board Name Please enter only alphabets


*
Please enter Seat No. Name Please enter only digits

*
Please enter your no of attempts Sem III Invalid
Please enter your no of attempts Sem IV Invalid

*
Please enter Marks Obtained Please enter only digits
Please enter Out of Marks Please enter only digits
Please enter sem 1 letter grade Invalid Grade!
   
*
Please enter Marks Obtained Please enter only digits
Please enter Out of Marks Please enter only digits
Please enter sem 1 letter grade Invalid Grade!
   


Please enter IMCOM Entrance Score. Please enter only digits Please enter a valid score



To be filled in by students joining as REPEATERS
Last College Attended Details

Please enter Your College Name Please enter only alphabets College Name cannot be longer than 100 digits

Please enter Your Class Please enter only alphanumeric characters Class Name cannot be longer than 50 digits

Please enter Your Roll No Please enter only alphanumeric characters Roll No cannot be longer than 50 digits


   
Please tick one

Please enter only alphabets Examination Name cannot be longer than 100 characters

Please enter only numeric characters Seat No cannot be longer than 20 characters


Please enter only alphanumeric characters Center cannot be longer than 50 characters


Part "C"
PARTICULARS OF PARENTS/GUARDIANS

Please enter {{father_husband_name}} Please enter only alphabets {{father_husband_name}} cannot be longer than 50 characters
Please enter Mother's Name Please enter only alphabets Mother's Name cannot be longer than 50 characters

Please enter only alphabets {{father_husband_qualification}} cannot be longer than 50 characters
Please enter only alphabets Mother's Qualification cannot be longer than 50 characters

Please enter only alphabets {{father_husband_occupation}} cannot be longer than 50 characters
Please enter only alphabets Mother's Occupation cannot be longer than 50 characters

Please enter Contact Number Please enter only digits Phone number should be atleast 7 digits Phone Number cannot be longer than 11 digits
Please enter only digits Parents Number (Residential) cannot be longer than 11 digits

Please enter only digits Parents number (office) cannot be longer than 11 characters

Please enter Guardian's Name Please enter only alphabets Guardian's Name cannot be longer than 50 characters
Please enter Guardian's Relation Please enter only alphabets Guardian's Relation cannot be longer than 50 characters

Please enter only digits Guardian's Number cannot be longer than 10 digits

*


Part "D"
EXTRA CURRICULAR ACTIVITIES




Part "E"

Please select atleast one!

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Please enter a reason




Part "F"
ATTACH DOCUMENTS


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Upload Student Profile Picture


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Upload Student Signature

   
Please tick one

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Upload Parent/Guardian Signature





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I hereby declare that the information provided by me is true, complete and correct to the best of my knowledge and understand that my admission is liable to be cancelled in the event of any information found to be incorrect.
By Clicking on the submit button below, I acknowledge that I have read and agree to be bound by all the terms and declaration mentioned in this admission form

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Successfully Submitted Application Form. Kindly get the Printed copy of this pdf form on the day of admission in college. Kindly attach your photo, if not generated in the pdf. Student and Parent/Guardian signature if uploaded, will not be generated in the PDF. Click above to Generate PDF of the Submitted form and send the copy of the same to your email address(Please Check spam folder, if email is not received).



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