GISM – Graduate Institute of Science and Management

1. GISM Student ID No.

If you have already given a GISM Student ID number.

2. Personal Details

Name with initials

Full Name

First Name / Preferred Name

Gender:

Male		Female

Date of Birth

Citizenship

NID Number

Passport Number

3. Contact Details

Permanent Address

Mailing Address
if different to above

Phone (daytime)

Phone (evening)

Mobile

Fax

4. Academic Qualifications

G.C.E. London or Local O/L Examination

School Attended	Year	Results


Ex: Ananda Collage - Colombo	2010	8A+2C

G.C.E. London or Local A/L Examination

School Attended	Year	Results


Ex: Ananda Collage - Colombo	2010	2B + 1C

Other Qualifications
(If not applicable, leave blank)

Institute / University	Year	Qualification

5. English Language proficiency

Excellent		Good		Basic

Have you sat an English language competency test?

Yes

If yes, please provide the following details:

Name of the test

Score

Year

6. Health and Disabilities

Do you have any disability, impairment (including learning disabilities), long term injury
or chronic medical conditions that may impact in your ability to study and/or participate in
university activities?

Yes

No

If yes please provide details below:

7. Declaration

The submission of false information or forged documentation in support of this application will automatically disqualify a student from enrollment. The submission of this application for
admission is deemed to be acceptance of these terms.