1. No category

Category:
General / SC-ST
INSTITUTE OF HUMAN RESOURCES DEVELOPMENT
(Established by Government of Kerala)
Admission to the Colleges of Applied Sciences(IHRD) under M.G.University
Application for Admission to Degree Programme during 2015–2016
(for office use only)
Register No:
Registration
fee remitted
Receipt No.
& Date
Note: 1. Read the prospectus and instructions carefully before filling up the Application Form.
2. The Application Form duly filled should be sent to the Principal of the College of
Applied Science where the applicant desires to get admission.
1.
Name of the College where admission is sought.
College of Applied Sciences......................................................
Choice – I ……………………………………………………
2.
Course applied for :
Choice – II ……………………………………………………
Choice – III ……………………………………………………
Choice – IV ……………………………………………………
a) Name of the applicant in full
(Block letters, initials at the end)
3.
b) Nationality
c) Caste & Religion
4.
Date of birth
5.
Sex (Write Male or Female)
6.
Permanent Address with Pin Code.
7.
8.
a) Address to which communications are to be sent
b) Telephone No.
c) Cell No.
d) email Id
I) Name of Father and occupation
II) Name of Mother
III) Name of Guardian (if parents are not alive)
iv) Annual family income
2
9.
Are you a native of Kerala? Write ‘Yes’ or ‘No’
10.
Do you belong to Scheduled Caste or Scheduled
Tribe? Write ‘Yes‘ or ‘No,’ If ‘yes’, write community
11.
Do you belong to any other community eligible for
reservation as per prospectus. Write ‘Yes ‘or ‘No’. If
‘Yes’, write (1) Community
(2) Annual family income
Details of qualifying examination passed
I) Name of Examination
II) Reg. No. and Year of Examination
III) Optional Subjects
12.
IV) Name of Board
V) Name of institution studied with state
VI) No. of chances taken for passing the examination
Have you passed the qualifying examination from a
13. THSS managed by IHRD? Write ‘Yes’ or ‘No ‘ If ‘Yes’
write the name of school
14.
Details of proficiency in NCC/NSS
(attach copies of certificates)
15.
Are you a dependant of Jawan/ Ex- servicemen,
If ‘Yes, write the relationship and attach the proof
Details of marks in the qualifying examination (Attach attested copy of the mark list.)
Particulars
Grade
Marks
Secured
(if any)
Maximum
Marks
(if any)
Part – I English
Part-III Optionals
16.
1. ...................................................................................................................
2. ..................................................................................................................
3. ..................................................................................................................
4. .................................................................................................................
Marks obtained in part III as per prospectus conditions less marks for handicapped + marks for Commerce
subjects (max 150 marks, Min 50 marks in each of the three subjects of Commerce combination)
Are you eligible for local reservation If yes, Name of
the panchayath / Thaluk in which the educational
17. institution is situated, from which you have passed
the qualifying examination(attach the certificate from
the school)
3
DECLARATION
1.
Certified that I had passed my qualifying examination in the .................. appearance.
2. I hereby solemnly and sincerely affirm that statements made and information furnished in my
application and also in all the enclosures thereto submitted by me are true. Should it however be found
that any information furnished therein is untrue in material particulars, I realize that I am liable to
criminal prosecution and also agree to forgo my seat.
3. I have fully read the conditions for admission to B.Sc Computer Science/B.Sc Electronics programme
/B Com with Computer Applications/Taxation in College of Applied Science as contained in the
prospectus and I agree to abide by them.
Signature of Parent/Guardian
Signature of Applicant
Place:
Place
Date:
Date:
DECLARATION
I have read the Act relating to the prohibition of ragging in full along with details of
punishment for ragging and fully understood its contents. I also understood that if I am found guilty
of ragging, I am liable to be punished appropriately.
Place:
Signature of Applicant:
Date:
Name:
DECLARATION
I have read the Act relating to the prohibition of ragging and agree to abide to the punishment meted out to
my ward in case he/she is found guilty of ragging
Signature of Parent/Guardian:
Place:
Name & Address:
Date :
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