Application No. Date of Regn.:
MADHAVARAM MILK COLONY GATE ROAD, MADHAVARAM, CHENNAI-600060.
APPLICATION FOR ADMISSION 200  - 200
B.COM., B.C.S., B.C.A. & B.Sc.(COMPUTER SCIENCE), B.I.S.M.
[ Tick the course applied ]
1.Name of Applicant (in Block Letters):  
2.Date of Birth : 3.Community: OC  BC  MBC/DNC  SC/ST
4.Nationality : 5. Caste/Religion :
6.Mother Tongue :
7.Part I Language: 8.Sex:  F  M
9. Name of Parent/Guardian

 

 12.Address for communication

 
10. Occupation and office address:

 
13. Tick the appropriate box:

Physically
Handicapped
Children of
Ex-Serviceman
Tamil Origin
from Andaman & Nicobar
Sports/
NCC/NSS
11.Annual income :
14. Medium of Instruction: a) Upto X std.: b) XII std.:
15.School last studied with location
16. Qualifying Examination Passed (Tick the appropriate box):    State Board   CBSE   Other Boards
Subject * Marks Obtained Max. Marks Month/Year of passing Reg. No. No. of attempts
Part I          
Part II          
Part III          
           
           
           
           
*Xerox copy of Plus Two Mark sheet to be enclosed

17. Have you applied for Engineering Course: Yes No
18.Particulars of other courses applied in this college:

         I declare that all the particulars furnished above are true and correct. I assure you that I will abide by the rules and regulations of the collage.


Signature of Parent/Guardian Signature of Applicant