APPLICATION No. : AYYA NADAR JANAKI AMMAL COLLEGE · AYYA NADAR JANAKI AMMAL COLLEGE [Autonomous, affiliated to Madurai Kamaraj University, ... Essay writing Poem composing Acting

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

[

]


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]


2015 – 2016



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)


__________________________________________________

_______________________________Pin _______________

Taluk _________________ District ______________________


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 :





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


TRANSFER

[ ‘A’

]


1

2 3

4 5

6 SC ST MBC DNC BC FC 7

8 i)

ii)

iii)

9.

___________________________________________________

___________________________________________________

___________________________________________________

__________________ __________________

____________ _______________

/ ?

:


*/

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)



____________________________________________ _______________________________________________

____________________________________________ _______________________________________________

_____________________________ Pin ___________ _____________________________Pin _______________

Taluk _____________________ District ____________ Taluk _____________________ District _______________

Phone No. with STD Code _______________________ Phone No. with STD Code _________________________

Mobile No. ___________________________________ Mobile No. ______________________________________

E-mail:



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 _________________________________________________________________________




S.No. Level Event Rank

Winner / Runner


Any other remarks

1. School

2. Zonal

3. District

4. Mini-divisional

5. Divisional

6. Mini-state

7. State

8. National




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

_____________________________________________________________________________________________

_____________________________________________________________________________________________




_____________________________________________________________________________________________



_____________________________________________________________________________________________





2. Attested Photo copies of the Mark Statement /certificates in support of differently abled / Ex-serviceman should be attached.





/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]


2016 – 2017



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)


__________________________________________________

_______________________________Pin _______________

Taluk _________________ District ______________________


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:





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


TRANSFER

[ ‘A’

]


1

2 3

4 5

6 FC BC MBC DNC SC ST 7

8 i)

ii)

iii)

9.

___________________________________________________

___________________________________________________

___________________________________________________

__________________ __________________

____________ _______________

/ ?

:

:


*/

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)



____________________________________________ _______________________________________________

____________________________________________ _______________________________________________

_____________________________ Pin ___________ _____________________________Pin _______________

Taluk _____________________ District ____________ Taluk _____________________ District _______________

Phone No. with STD Code _______________________ Phone No. with STD Code _________________________

Mobile No. ___________________________________ Mobile No. ______________________________________

E-mail:



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 _________________________________________________________________________




S.No. Level Event Rank

Winner / Runner


Any other remarks

1. School

2. Zonal

3. District

4. Mini-divisional

5. Divisional

6. Mini-state

7. State

8. National




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

_____________________________________________________________________________________________

_____________________________________________________________________________________________




_____________________________________________________________________________________________



_____________________________________________________________________________________________





2. Attested Photo copies of the Mark Statement / Community certificate / Certificates in support of differently abled / Ex-serviceman should be attached.





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APPLICATION No. : AYYA NADAR JANAKI AMMAL COLLEGE · AYYA NADAR JANAKI AMMAL COLLEGE [Autonomous, affiliated to Madurai Kamaraj University, ... Essay writing Poem composing Acting