Vacaspatimisra Tattvakaumudi Von Srinivasa Ayya Srinivasan_1967
APPLICATION No. : AYYA NADAR JANAKI AMMAL COLLEGE · AYYA NADAR JANAKI AMMAL COLLEGE [Autonomous,...
Transcript of APPLICATION No. : AYYA NADAR JANAKI AMMAL COLLEGE · AYYA NADAR JANAKI AMMAL COLLEGE [Autonomous,...
APPLICATION No. :
AYYA NADAR JANAKI AMMAL COLLEGE [Autonomous, affiliated to Madurai Kamaraj University, Re- accredited (3rd cycle) with ‘A’ Grade
(CGPA of 3.67 out of 4) by NAAC and College with Potential for Excellence by UGC]
SIVAKASI – 626 124
2014 – 2015
APPLICATION FORM FOR ADMISSION TO
B.A.(Economics) B.Com. B.B.A. B.Sc. ____________________(specify Major)
1. NAME
2. DATE OF BIRTH 3. COMMUNITY SC ST MBC DNC BC FC
4. CASTE 5. NATIONALITY 6. SEX M F Trans gender
7. i.) NAME OF THE FATHER
ii.) NAME OF THE MOTHER
iii) NAME OF THE GUARDIAN (State Relationship)
8. ADDRESS FOR COMMUNICATION __________________________________________________
__________________________________________________
_______________________________Pin _______________
Taluk _________________ District ______________________
Phone No. with STD Code_____________________________
Mobile No. _________________________________________
E-mail:
9. Are you differently abled?
10. Are you son / daughter of Ex-Service Man of Tamil Nadu origin?
11. Are you of Tamil Nadu origin from
Andaman Nicobar Islands?
12. Distinction in Sports/ NCC/ NSS
13. Are you the first graduate of your family?
14 Do you have below poverty line card / certificate
15. NAME & LOCATION OF SCHOOL LAST STUDIED :
16. QUALIFYING EXAMINATION PASSED : HSC / CBSE / ISC or EQUIVALENT GENERAL VOCATIONAL
SUBJECT MARKS* MAXIMUM MONTH & YEAR OF PASSING REGISTER No. No. of ATTEMPTS
PART I : TAMIL / 200
PART II : ENGLISH 200
PART III
1. 200
2. 200
3. 200
4. 200
TOTAL 1200
* CALCULATE TO THE MAXIMUM OF 200 I declare that all the particulars furnished above are true and correct I declare that I will abide by the rules and regulations of the college.
I declare that I am aware of the law regarding ragging as well as the punishments, and that if found guilty of ragging, is liable to be punished appropriately.
Place : Date : SIGNATURE OF THE PARENT / GUARDIAN
Note : Fill up the application either in English or Tamil SIGNATURE OF THE APPLICANT
CERTIFICATES VERIFIED : FOR OFFICE USE ONLY ADMITTED
PRINCIPAL
Signature of the Staff who processed the Application_________________________
Signature of the Head of the Department________________________________
HSC MARKS COMMUNITY
CONDUCT SPL CATEGORY
TRANSFER
[
]
B.A.(Economics) B.Com. B.B.A. B.Sc. ____________________(specify Major)
1.
2. 3. SC ST MBC DNC BC FC
4. 5. 6.
7. i)
ii)
iii)
8.
___________________________________________________
___________________________________________________
___________________________________________________
__________________ __________________
____________ _______________
9.
10.
11.
12.
13.
14. / ?
:
16. : HSC / CBSE / ISC /
*/
I : / 200
II : 200
III
1. 200
2. 200
3. 200
4. 200
1200
*
:
: / : /
OTHER DETAILS 17. Religion 19. Age : _______ Years ________ Months
(as on date 01.06.2014) 18. Blood Group 20. Is the applicant married? Yes No
21. Savings Bank Account details: Bank Name : Place : Account Number : IFSC code: MICR code :
22. Information about Parent / Guardian Affix your
recent passport size
photograph here
Parent / Guardian
Name Educational Occupation Qualification
Monthly Income
(Rs.)
Father
Mother
Guardian (Specify
relationship)
No. of Children in the family : Male: Female :
Permanent Residential Address Official Address
____________________________________________ _______________________________________________
____________________________________________ _______________________________________________
_____________________________Pin ___________ _____________________________Pin _______________
Taluk _____________________ District ___________ Taluk _____________________ District ______________
Phone No. with STD Code_______________________ Phone No. with STD Code _________________________
Mobile No. _________________________________ Mobile No. _________________________________
E-mail:
23. Break in studies, if any
i) ________ years ii) From___________ To___________ iii) Reason________________________________
24. Co-curricular activities desired (Choose from the following) ( N.C.C. / N.S.S. / R.R.C. / C.C. / H.F.C.)
First Preference ___________________________________________________________________________
Second Preference_________________________________________________________________________
Third Preference___________________________________________________________________________
25. Has the applicant been subjected to any disciplinary action either by the School or the Hostel authorities at any time? Yes No
If yes, give details __________________________________________________________________________
26. Details of proficiency in Games / Sports, if any
S. No. Level Event Rank
Winner / Runner
Number of Certificates
Any other remarks
1. School
2. Zonal
3. District
4. Mini-divisional
5. Divisional
6. Mini-state
7. State
8. National
(If information given under this head is proved false later, he / she will be dismissed immediately)
27. Details of extracurricular activities – Tick the relevant box & mention the details of certificates
S.No. Activity Occasion Sponsor / Organizer Rank Number of Certificates
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Oratorical Talent
Essay writing
Poem composing
Acting
Vocal Music
Instrumental Music
Dance (Specify)
Mimicry
Computer Literacy
Drawing / Painting
Other items
(give details)
28. Was the applicant in receipt of any fee concession or scholarship in the school in which he studied last ? If so, the nature of the same with particular reference to the proceedings of the authority sanctioning the award
may be stated
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
29. Does the applicant need accommodation in the Hostel? Yes No If no, with whom does he / she propose to reside?
i) Name of the local guardian _________________________________Relationship __________________________
ii) Residential Address ___________________________________________________________________________
_____________________________________________________________________________________________
Pin ___________ Phone No. with STD Code_______________________ Mobile No. _________________________
iii) Official Address ______________________________________________________________________
_____________________________________________________________________________________________
Pin ____________ Phone No. with STD Code ______________________ Mobile No. ________________________
Note : 1. Application will be summarily rejected,
i) if it is incomplete or
ii) if the signatures are forged or bogus certificates are submitted.
2. Attested Photo copies of the Mark Statement /certificates in support of differently abled should be attached.
Payment of Fees Receipt No. Date Initials of the
Cashier Admission No.
Application Registration Fee
Tuition Fee & Special Fee
/ccm/app.13/adm.12/app.UG.Reg./4
APPLICATION No.
AYYA NADAR JANAKI AMMAL COLLEGE [Autonomous, affiliated to Madurai Kamaraj University, Re- accredited (3rd cycle) with ‘A’ Grade
(CGPA of 3.67 out of 4) by NAAC and recognized by UGC as College of Excellence]
SIVAKASI – 626 124
2015 – 2016
APPLICATION FORM FOR ADMISSION TO
B.A.(Economics) B.Com. B.B.A. B.Sc. ____________________(specify Major)
1 Name
2 Date of Birth 3. Nationality
Affix your recent passport size
photograph here
4 Religion 5. Caste
6 Community SC ST MBC DNC BC FC
7 SEX Male Female Transgender
8 NAME OF THE FATHER MOTHER GUARDIAN (State relationship)
9. ADDRESS FOR COMMUNICATION __________________________________________________
__________________________________________________
_______________________________Pin _______________
Taluk _________________ District ______________________
Phone No. with STD Code_____________________________
Mobile No. _________________________________________
E-mail:
10 Are you differently abled?
11 Are you son / daughter of Ex-Service Man of Tamil Nadu origin?
12 Are you of Tamil Nadu origin from Andaman Nicobar Islands?
13 Distinction in Sports/ NCC/ NSS
14 Are you the first graduate of your family?
15 Do you have below poverty line card/ certificate
16. NAME & LOCATION OF SCHOOL LAST STUDIED :
17. QUALIFYING EXAMINATION PASSED : HSC / CBSE / ISC or EQUIVALENT GENERAL VOCATIONAL
SUBJECT MARKS* MAXIMUM MONTH & YEAR OF PASSING REGISTER No. No. of ATTEMPTS
PART I : TAMIL / 200
PART II : ENGLISH 200
PART III
1. 200
2. 200
3. 200
4. 200
TOTAL 1200 * CALCULATE TO THE MAXIMUM OF 200 I declare that all the particulars furnished above are true and correct I declare that I will abide by the rules and regulations of the college.
I declare that I am aware of the law regarding ragging as well as the punishments, and that if found guilty of ragging, is liable to be punished appropriately.
Place : Date : SIGNATURE OF THE PARENT / GUARDIAN
Note : Fill up the application either in English or Tamil SIGNATURE OF THE APPLICANT
FOR OFFICE USE ONLY
CERTIFICATES VERIFIED : ADMITTED
Signature of the Staff who processed the Application ______________________ Signature of the Head of the Department ________________________________ PRINCIPAL
HSC MARKS COMMUNITY
CONDUCT SPL CATEGORY
TRANSFER
[ ‘A’
]
B.A.(Economics) B.Com. B.B.A. B.Sc. ____________________(specify Major)
1
2 3
4 5
6 SC ST MBC DNC BC FC 7
8 i)
ii)
iii)
9.
___________________________________________________
___________________________________________________
___________________________________________________
__________________ __________________
____________ _______________
/ ?
:
17. : HSC / CBSE / ISC /
*/
I : / 200
II : 200
III
1. 200
2. 200
3. 200
4. 200
1200
*
:
: /
: /
OTHER DETAILS
18. Blood Group 19. Age : _______ Years ________ Months
(as on date 01.06.2015)
20. Is the applicant married? Yes No
21. Savings Bank Account details: Bank Name :
Place : Account Number :
IFSC code: MICR code :
22. Information about Parent / Guardian
Parent / Guardian
Name Educational Qualification
Occupation Monthly Income (Rs.)
Father
Mother
Guardian (Specify
relationship)
No. of Children in the family : Male: Female :
Permanent Residential Address Official Address
____________________________________________ _______________________________________________
____________________________________________ _______________________________________________
_____________________________ Pin ___________ _____________________________Pin _______________
Taluk _____________________ District ____________ Taluk _____________________ District _______________
Phone No. with STD Code _______________________ Phone No. with STD Code _________________________
Mobile No. ___________________________________ Mobile No. ______________________________________
E-mail:
23. Break in studies, if any
i) ________ years ii) From___________ To___________ iii) Reason________________________________
24. Co-curricular activities desired (Choose from the following) ( N.C.C. / N.S.S. / R.R.C. / C.C. / H.F.C.)
First Preference _________________________________________________________________________
Second Preference _________________________________________________________________________
Third Preference _________________________________________________________________________
25. Has the applicant been subjected to any disciplinary action either by the School or the Hostel authorities at any time? Yes No
If yes, give details __________________________________________________________________________
26. Details of proficiency in Games / Sports, if any
S.No. Level Event Rank
Winner / Runner
Number of Certificates
Any other remarks
1. School
2. Zonal
3. District
4. Mini-divisional
5. Divisional
6. Mini-state
7. State
8. National
(If information given under this head is proved false later, he / she will be dismissed immediately)
27. Details of extracurricular activities – Tick the relevant box & mention the details of certificates
S.No. Activity Occasion Sponsor / Organizer Rank Number of Certificates
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Oratorical Talent
Essay writing
Poem composing
Acting
Vocal Music
Instrumental Music
Dance (Specify)
Mimicry
Computer Literacy
Drawing / Painting
Other items
(give details)
28. Was the applicant in receipt of any fee concession or scholarship in the school in which he studied last ? If so, the nature of the same with particular reference to the proceedings of the authority sanctioning the award may be stated
_____________________________________________________________________________________________
_____________________________________________________________________________________________
29. Does the applicant need accommodation in the Hostel? Yes No If no, with whom does he / she propose to reside?
i) Name of the local guardian _________________________________Relationship __________________________
ii) Residential Address ___________________________________________________________________________
_____________________________________________________________________________________________
Pin ___________ Phone No. with STD Code_______________________ Mobile No. _________________________
iii) Official Address ______________________________________________________________________
_____________________________________________________________________________________________
Pin ____________ Phone No. with STD Code ______________________ Mobile No. ________________________
Note : 1. Application will be summarily rejected,
i) if it is incomplete or
ii) if the signatures are forged or bogus certificates are submitted.
2. Attested Photo copies of the Mark Statement /certificates in support of differently abled / Ex-serviceman should be attached.
Payment of Fees Receipt No. Date Initials of the
Cashier Admission No.
Application Registration Fee
Tuition Fee & Special Fee
/ccm/app.13/14-15/app.UG.Reg./8
APPLICATION No.
AYYA NADAR JANAKI AMMAL COLLEGE [Autonomous, Affiliated to Madurai Kamaraj University, Re- accredited (3rd cycle) with ‘A’ Grade
(CGPA of 3.67 out of 4) by NAAC, recognized as College of Excellence by UGC and Star College by DBT]
SIVAKASI – 626 124
2016 – 2017
APPLICATION FORM FOR ADMISSION TO
B.A.(Economics) B.Com. B.B.A. B.Sc. ____________________(specify Major)
1 Name of the applicant: (In Block Letters as in T.C.)
2 Date of Birth: Age(as on 01.06.2016):_____Years ___ Months
3. Nationality
Affix your recent passport size
photograph here
4 Religion 5. Caste
6 Community FC BC MBC DNC SC ST
7 SEX Male Female Transgender
8 NAME OF THE FATHER MOTHER GUARDIAN (State relationship)
9. ADDRESS FOR COMMUNICATION __________________________________________________
__________________________________________________
_______________________________Pin _______________
Taluk _________________ District ______________________
Phone No. with STD Code_____________________________
Mobile No. _________________________________________
E-mail:
10 Are you differently abled? **
11 Are you son / daughter of Ex-Service Man of Tamil Nadu origin? **
12 Are you of Tamil Nadu origin from Andaman Nicobar Islands?
13 Distinction in Sports/ NCC/ NSS
14 Are you the first graduate of your family? **
15 Do you have below poverty line card/ certificate
16. NAME OF THE SCHOOL LAST STUDIED:
Place:
17. QUALIFYING EXAMINATION PASSED : HSC / CBSE / ISC or EQUIVALENT GENERAL VOCATIONAL
SUBJECT MARKS* MAXIMUM MONTH & YEAR OF PASSING REGISTER No. No. of ATTEMPTS
PART I : TAMIL / 200
PART II : ENGLISH 200
PART III
1. 200
2. 200
3. 200
4. 200
TOTAL 1200 * CALCULATE TO THE MAXIMUM OF 200 I declare that all the particulars furnished above are true and correct
I declare that I will abide by the rules and regulations of the college. I declare that I am aware of the law regarding ragging as well as the punishments,
and that if found guilty of ragging, is liable to be punished appropriately.
Place : Date: SIGNATURE OF THE PARENT / GUARDIAN
Note: Fill up the application either in English or Tamil SIGNATURE OF THE APPLICANT
FOR OFFICE USE ONLY
CERTIFICATES VERIFIED : ADMITTED
Signature of the Staff who processed the Application ______________________ Signature of the Head of the Department ________________________________ PRINCIPAL
** Attach necessary certificates
HSC MARKS COMMUNITY
CONDUCT SPL CATEGORY
TRANSFER
[ ‘A’
]
B.A.(Economics) B.Com. B.B.A. B.Sc. ____________________(specify Major)
1
2 3
4 5
6 FC BC MBC DNC SC ST 7
8 i)
ii)
iii)
9.
___________________________________________________
___________________________________________________
___________________________________________________
__________________ __________________
____________ _______________
/ ?
:
:
17. : HSC / CBSE / ISC /
*/
I : / 200
II : 200
III
1. 200
2. 200
3. 200
4. 200
1200
*
:
: /
: /
OTHER DETAILS
18. Blood Group
19. Is the applicant married? Yes No
20. Savings Bank Account details: Bank Name :
Place : Account Number :
IFSC code: MICR code :
21. Information about Parent / Guardian
Parent / Guardian
Name Educational Qualification
Occupation Monthly Income (Rs.)
Father
Mother
Guardian (Specify
relationship)
No. of Children in the family : Male: Female :
Permanent Residential Address Official Address
____________________________________________ _______________________________________________
____________________________________________ _______________________________________________
_____________________________ Pin ___________ _____________________________Pin _______________
Taluk _____________________ District ____________ Taluk _____________________ District _______________
Phone No. with STD Code _______________________ Phone No. with STD Code _________________________
Mobile No. ___________________________________ Mobile No. ______________________________________
E-mail:
22. Break in studies, if any
i) ________ years ii) From___________ To___________ iii) Reason________________________________
23. Co-curricular activities desired (Choose from the following) ( N.C.C. / N.S.S. / R.R.C. / C.C.C. / H.F.C./G.P.S.C./EXNORA)
First Preference _________________________________________________________________________
Second Preference _________________________________________________________________________
Third Preference _________________________________________________________________________
24. Has the applicant been subjected to any disciplinary action either by the School or the Hostel authorities at any time? Yes No
If yes, give details __________________________________________________________________________
25. Details of proficiency in Games / Sports, if any
S.No. Level Event Rank
Winner / Runner
Number of Certificates
Any other remarks
1. School
2. Zonal
3. District
4. Mini-divisional
5. Divisional
6. Mini-state
7. State
8. National
(If information given under this head is proved false later, he / she will be dismissed immediately)
26. Details of extracurricular activities – Tick the relevant box & mention the details of certificates
S.No. Activity Occasion Sponsor / Organizer Rank Number of Certificates
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Oratorical Talent
Essay writing
Poem composing
Acting
Vocal Music
Instrumental Music
Dance (Specify)
Mimicry
Computer Literacy
Drawing / Painting
Other items
(give details)
27. Was the applicant in receipt of any fee concession or scholarship in the school in which he / she studied last? If so, the nature of the same with particular reference to the proceedings of the authority sanctioning the award may be stated
_____________________________________________________________________________________________
_____________________________________________________________________________________________
28. Does the applicant need accommodation in the Hostel? Yes No If no, with whom does he / she propose to reside?
i) Name of the local guardian _________________________________Relationship __________________________
ii) Residential Address ___________________________________________________________________________
_____________________________________________________________________________________________
Pin ___________ Phone No. with STD Code_______________________ Mobile No. _________________________
iii) Official Address ______________________________________________________________________
_____________________________________________________________________________________________
Pin ____________ Phone No. with STD Code ______________________ Mobile No. ________________________
Note : 1. Application will be summarily rejected,
i) if it is incomplete or
ii) if the signatures are forged or bogus certificates are submitted.
2. Attested Photo copies of the Mark Statement / Community certificate / Certificates in support of differently abled / Ex-serviceman should be attached.
Payment of Fees Receipt No. Date Initials of the
Cashier Admission No.
Application Registration Fee
Tuition Fee & Special Fee