ETHIRAJ COLLEGE FOR WOMEN (AUTONOMOUS) SS # 70, Ethiraj Salai, Chennai - 600 008 AFFILIATED TO THE UNIVERSITY OF MADRAS APPLICATION FOR ADMISSION 2015-2016 B.A. / B.Sc., / B.Com. / B.B.A. / B.C.A. Application No. APPLICATION FORM TO BE FILLED IN BLOCK LETTERS ENTER COURSE CODE YOU ARE APPLYING FOR (REFER INSTRUCTIONS AT THE BACK) 1. Name of the Student as per the School Transfer Certificate 2. Parent’s Name / Guardian’s Name 2(A) Relationship F - Father M - Mother G - Guardian 2(B) Occupation 2(C) Gross Annual Income of the Family S - Self G - Govt. P - Private 3. Date of Birth (DD / MM / YYYY) 4. Community Code OC BC BCM (BC Mulsim) MBC 7. Are you of Tamil Origin from the 6. Nationality Andaman and Nicobar Islands? INDIAN Yes / No NRI OTHERS 12. Distinction in Extra Curricular Activities / Co-Curricular Activities State Level National Level International Level 5. Caste as per School & Community Certificate DNC SC SCA (Arundatiyar) ST 8. Are you a first generation learner? Yes / No 13. Are you a daughter of an Ex-Service man? Yes / No 9. Distinction in Sports A1-District B2-State C3-National D4-International 14. Are you Differently - Abled? Yes / No 17. Address for Communication (Please do not write your name again) 10. NCC Yes / No 11. NSS Yes / No 15. Are you from Rural Area? Yes / No 16. Do you want to be considered for Admission under NRI Quota? Yes / No City Pincode State Landline Number Mobile Number Email ID 18. NAME AND LOCATION (DISTRICT) OF SCHOOL LAST ATTENDED 19. Board of Qualifying Examination Passed Tamil Nadu State Board Central Board Others 20. Medium of Study at +2 level Tamil English Others Subject Code (Refer Instructions at the back) 22. Statement of Marks Month 21. Register Number Year of Marks / Grade Appearance obtained Maximum Marks No. of Attempts LANGUAGE ENGLISH SUBJECTS PLACE : DATE : DECLARATION SIGNATURE OF THE APPLICANT I declare that all the particulars furnished above are true and correct. I submit that I will abide by the rules and regulations of the college. SIGNATURE OF PARENT / GUARDIAN Note : 1. Incomplete / Incorrect applications will be rejected. 2. There should not be any overwriting. FOR OFFICE USE ONLY SIGNATURE OF STAFF WHO PROCESSED THE APPLICATION ............................... SIGNATURE OF HEAD OF THE DEPARTMENT ........................................................... PRINCIPAL ................................................... ADMISSION No. ...........................................