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VYSYA COLLEGE
Accredited with Five Star Status (“A” Grade) by NAAC
(CO-EDUCATIONAL INSTITUTION)AFFILIATED TO
PERIYAR UNIVERSITY
RAMAKRISHNAPURAM,
MASINAICKENPATTY,
AYOTHIYAPATTINAM (Po), SALEM – 103
Ph: 0427 – 2240107, 2241428,
Hostel: 2241056, 2243676, 2243677 |
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APPLICATION NO
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COURSE |
APPLICATION FOR ADMISSION-PG COURSE
(TO BE FILLED IN CAPITAL LETTERS) |
Hostel Required |
yes
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No
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1. Name:______________________________________ |
Affix
Your passport
Size
photo here |
2. Date of Birth: _____________ 3. Age: ______ 4.Sex:_____ |
5.(a) Nationality: ____________ 5.(b) Region: ______________ |
6.Community |
OC |
BC |
MBC |
SC |
ST |
7.Caste__________ |
8. Address for Communication_____________________________________________ |
_____________________________________________________________________ |
_____________________________________________________________________ |
Pin code_________ phone no: std code: cell:
Off: resi: |
9.(a) if handicapped |
physically |
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Specify the percentage_______ (b) Blood Group_______ |
visually |
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10. if you are Ex-service mens |
Son |
Yes |
Designation________no___________ |
daughter |
No |
11.Language for communication with parents |
Tamil |
English |
Hindi |
√ the relevant box |
12. Are you Tamil origin of Andaman nicobor islands or any other state? |
13. Whether any of your family members studied / is studying in this college? If so give details
name________________ class____________ year________relationship __________ |
14. Details of parents |
FATHER/GUARDIAN |
MOTHER |
Name : |
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Qualification : |
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Occupation : |
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Annual Income : |
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FOR OFFICE USE ONLY |
ACADEMIC YEAR__________________ |
ROLL NO___________ |
T.C NO ______
DATE OF ISSUE______ |
DATE OF ADMISSION______________ |
COURSE___________ |
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