GISM – Graduate Institute of Science and Management

2. Personal Details

Title

Surname:

Forename(s):

Postcode:

Date of Birth

National ID Number :

NID Number

Passport Number

3. Contact Details

Permanent Address

Mailing Address
if different to above

Web Address

Phone (daytime)

Phone (evening)

Mobile

Fax

Do you have a current driving licence?

Yes

Do you require Employment visa to work in Sri Lanka?

Yes

4. Education and Qualifications

Please provide details of educational qualifications obtained:

From	To	College, Institution, University	Examinations taken/to be taken and qualifications obtained
General Education		College, Institution, University	Examinations taken/to be taken and qualifications obtained

Training and Professional Development

Please provide details of relevant training and development taken:

Course	Year	Institute

6. Membership of Professional Bodies / Professional or Vocational Qualifications

Name of Body / Qualification	Class / Grade	Date

5. Present or Most Recent Employment
Job Title:		From :
Company, Name and Address :		To :
		Current Research if any :

6. Previous Research Work (Please provide a brief description of the research and related employment)
Please continue on a separate sheet if necessary

Research Title:

From :

To :

Company, Name and Address :

7. References

Previous Research Work (Please provide a brief description of the research and related employment)
lease continue on a separate sheet if necessary.


	Name :
	Address :
	Telephone :
	Email :

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.