SudharsanENGINEERING COLLEGE

SATH IYAMANGALAM, P U DU KKOTTAI . 522 50'I ,

04339- 240830

04339 - 240840

04335- 240205

E.mail: principal@sec.ac. inName of the Student

Date of Enrollment Branch Allotted

Principal

Please affixyour Receni

Passport SizePhoto

1. Preferred Branch I computer science and Engineerinn n aivit Enginoering

| | Ebaronics and comnunication Engineering | | Mechanicat EngineeringHL__l Eleciricaland El6clronica Engineering L l lnfomation Tochnology

2. Name of Candidate

3. (a) Name of Father

(b) Name of Mother

4. Address for Communication

Area code Phone No.Pin Code:

Phone: Mobile:

5. Permanent Address

Aroa code PhoneNo. Pin Code:

Phone: Mobile:

6. sex nMare lremare T.DateorBirth(ason rst;uryy ffi If iTffi8. MotherTongue . g.Nationali9

on"fTl

10. Place of Birlh :

Village/Town/City

District

State

'11. Caste / Community It" fl.t !nrrec IoHc BC Io"12. Community Certificate No, & Date ff-t t-t-t t-fm13. Place of issue

{NoE,:,thE.s Sfroutd'bq 0i glltelenee in the catte mtErlo'lEd li ![? flemnllrltt llr.ns&r Carlitjfat

14. Occupation of Par.nl / Guardian

Office Add..ss

Pin Code:

Phone: Mobile:

'15. Annual lncoma of Parent / Guardian in Rt

16, Whether admission is sought under NRlAudta I Y€5 fl*o

{Nqlr l AtteBt€d Xeror CoPY t True C

ln casc of more than ona attompt. ieror, Coof Mrik strr9l rnc ll.n,Ilue,:!!pt,pf

]!,l11111 sli!

rter cs *ttiiate ts lib.riia,ti,i;itor!!:,ql:a!!::4Fp9ilt!ter:,itiouiS ht

19. Achievement in sports

S.No Event Level of Cornpetition Year Place / Rank

17. Oetails of Schooling (HSC / Oiploma / Oegree)

S.No Name and Addre3s of School / Collego HSC / Olploma /Degiee

Year ofPassing

Marts (Total)

'18. Marks in O ng Examination

ACADEMIC VOCATIONAL DIPLOMA

Maths t2o0&-%PhysiG& -------J,100&-%Chemistry

Overall Malks t200

Maths t20oa

-'/oVocationalSubjects

-600/800

&-%Average

OverallMarks

Pre final sem. MaA

-

%

Finrl sem, Ma.k

-'/"V &Vl Marks ./.

rnd ilrlnller Crdltiia{e sllilk sitq!t!: sf ,al! :*tpf .

20. Extra Curdcular ActivitiGsS.No Aciiviiy Deiails

21. Details of Qualifylng Examination

Signature ot Parent / Guardian Signatu10 ol Applicant

FOR OFFICE USE ONLY

Detects I lncomplete particularr it any

Slgnature of the Verifying officer

I etisioru I ror etisiur"Oesignation:

JOINT DECLARATION BY THE APPLICANT AND PARENTl/ We here by solemnly and sincorely alfirm lhat1. The statments made and the information furnished by m€ in the application as also in lhe enclosure submitt€d by

me are true. should it however, be found that any information furnishod there is false in material particularB onverification at a later3tage,lam liable lor criminalprosecution and lshould forego my seat in this instituion and my nam6removed fiom th€ rolls of the instilrrtion at whatever stage of study I may, bs at the time of deteclion of such wrong particulais.

(dairernu6$(i) 6r6r6rrrn FFuut66ir6s 6norIrtu66h €lo@rigrtb e-dirr6m. Solpndr t6or{i66ir DtirFDr6fin6r6rn 6din6lna*6itrIl:Lfi@ €tbD FloIgridr6iit@' e-6hdflr*drnl6orcDno 6ogrrftn6fl€'ljgr Fr6dr 6II'F So6l)oj@rinrir 666@rb €ur6,rb 6r;6iut6 6r6n666firi6riurl E|L66F 8g6OJ 6a6car6r 6r6rxoFul6 etglGoror.

2. My Son, oaughter i Wart should conform strictly lo all the rules and r€gulations in force now or which may beintroduced ln the institution hereafter and thal I realise that br€ach of discipline and rules on my son's/ daughter's,ward'3 part would entril summary torfeiture of his/ her seat in th. institution.(6r6rd m6srl m66ir 66grrnlIi(i) e-6ir6o FtLlh e@fi€i dtodotr'6@6€, 6i@rluL{3 FLitullor FLt]u[6ir 5r6r&Iir6rigrn dSd0oD6@';€' q06ur6olrb e@d,r66rI!r6016 Dl-ggrri 6{igrnlrn(i) 8@g$r 6t6iuaOsorgrr;€r/ar61@irir@ €{Gffin6nu'll 6LioF €}UuijFol@rnorndr/atroir 6rsru6F'rlli) 4tdlcoldrr.

3. I am eware that if my sonl daughter / ward does nol pul in a minimum of 75% attendancs during the !emester intheory, drawing and practical classes individually my son/ daughter/ ward wlll not be permitted for the examinations.dFu6dr6D, orlodoofir, or6olu1-dootD or€riq66fidr 0rci06 ?5 6a@66[6r66ir F6ffiF6ff6ul cEoor 6r@r@6,6li)6or6alltrrir 6rsrg, rc66r1m66ir 6Diol 6r@F e{@|todri6lotrLl-rdr 1r-noir erdruoEiqrir g16r e{dlcorar.

4. ln case my son, d.ughter / rvard becone6 a scholar!hip holder or com6s to enjoy deucational conc6ssions lik€half fe€, etc, and does not Bhow spacial progress, and that if my sons'5 , dauqhier's / ward's conduct andcharacter are not good. the scholarship or educational conce3sions are liable to be cancellod.6r6drd to.6@r/ to66ii epiun6 €{n6a@Jir}6 r5rairdiit6r6A[Lrg6 D6r6rL6oF 66r!t FLJiDngbarorgurir@r/ s6r@ie€r orurirdnu6rb 66d Fgro666h, sr@ g!'6a6oEtro6 lDiort eroD s96aiaptro66un6rDoor nigl aetilldlljorb 6rdrlotiut6 erd€or6r.

5. lly son/ daughter, ward is awar. that br6ach ol discipline and rules or bad conduct in curric!lar and extracurdcuhri activiti$ vrill elso entail rummary forfoiture of his I herseatintho institution in addhion to such othor procsedingBthat may be taken against him I h.r.(6d64 6niDF rcbD|lb 6d)64 rrfnF Dl-orlgdio6Gdnd' A@nir66rl'tr6coltr, Fdr6drLiio9 €ldrdlcur FLIbOTa6treinLrri a6ro, lo6dr /lD66ir 668[nln(i) {'6jbEl 6;6nuUD €torgJ*@ €r6ne6irutl eLi6F 6$iundr/ 64tirun6ir daruoDutrb €{dl6or6r.

6. lam aw.rothal ilmy 3on/ daughter/ward is admited into Hostel, he/ showillstriclly abide by the rules and r€gulation in forcein the Hostel and that any breach of discipline or rulos or any onruly conducl or undersirable activitles on his /her part willbe summarily dealt with and he/ she 6hall be remov6d from ths Hostel and the institution in additionto ruch other proceeding thai may be taken against him / her.aan6 rnaan/ roocir origtrrn 6n6$und' €rd,6 utrtirol;) 6{n€Urn 6tOO dn6dootr}6,@.6@ prulo ElrlurdrrEliun6ir dorott Od!!fu6@rlDll66orlr 6in6dD@[,6@'.gq' qprbunor oau.rrireoh to60,til d66u668tr6FLor'9do666ntn roul:LrGdtr 16li)€lrfl to68rqr 6a0$l6l(i) €}@Jbbi dl;EnuOarror /orron ooruoEqti tirnerinGrc6 Dl-orlg.bo666h 6r6l;6iruot 6rdrudrFnjlb 4ll€ordr

7. lam at{are t hat if my son/ daughter, ward indulges in any unlawful aclivitios outside the collegecampus the coll.geis not responsible for any cofls€quences.6ro15r lo6d/ lo66il 6r$gtrfrl;@ odsrncru ttl dclrpl!n6r FLorgriio665ine leouilr(i) 4xpdr (n6r6no6r6{6@ri@' 6{i)€Irfl dtitF 6dFi6g6 6tunglrlun6r5l 6rdrBjlb andtGordr.

8. We undorctand that f6es onc6 paid will not b! rofunded.(6l@ oooD o6g,i9ur E66adr6l:t-mrfi 6@66 orsr;r6iulmrtLngr 6ror6oF Frrir66h erltGomdr.)

9. lf on a laler date, the fees are r€vised by the Governm€ni or the Universily we ars ready to abide lhe revision.(erI6trr,ir6 jit9rc@Ir u@6oori6lq6FFn€on 6e6d6l:l@rli mrbDirutlnri] eto9 qtbgJ 6lFg6F66mdesGDnlb.)

Place:

Oate :

Siqnatu.e of Applicant Signature of the Parent / Guardian

(Note : The Guardia qxecqte the abovo deqlEratiot gnly il both parsnls ate not aiiYel: