APPLICATION No. 2015 - 2016 MP / App. Receipt No. ADMISSION No. Fee Receipt No. & Date V.V. VANNIAPERUMAL COLLEGE FOR WOMEN (Autonomous) (Belonging to Virudhunagar Hindu Nadars) VIRUDHUNAGAR. (Re-accredited with 'A' Grade by NAAC) PHOTO Estd. 1962 SELF FINANCE APPLICATION FORM FOR ADMISSION TO M.Phil MAJOR 1. NAME 2. DATE OF BIRTH 4. 6. 3. CASTE BLOOD GROUP FC BC MBC / DNC SC / ST (Xerox copy should be enclosed) 5. COMMUNITY NATIONALITY 7. MARITAL STATUS Married / Un Married OCCUPATION ANNUAL INCOME 8. NAME FATHER MOTHER or GUARDIAN : (State Relationship) 9. ADDRESS FOR COMMUNICATION Pin Code Mobile No. Phone No. 10. A) HOW FAR IS YOUR NATIVE PLACE AWAY FROM OUR COLLEGE ? Hostel accommodation will not be given to those who live within a radius of 20 kms. A xerox copy of the family ration card should be attached. B) IS DIRECT BUS FACILITY AVAILABLE FROM YOUR PLACE TO VIRUDHUNAGAR ? C) DOES THE APPLICANT NEED HOSTEL FACILITY ? kms. AVAILABLE / NOT AVAILABLE YES / NO DETAILS OF PREVIOUS STUDY AND MARKS OBTAINED IN DEGREE EXAMINATION Note : In case of students who have written Fourth Semester Exams in April 2015 and results have not yet been published, they should furnish the marks upto Third Semester 11. Academic Qualification Exam Passed University / College In case of break in studies specify the reason Month & Year of Passing Marks obtained in Part III Percentage of Marks 12. Details of Teaching / Research experience, if any : Position Held Teaching Experience / College / School Research Experience Year 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. Place : Date : SIGNATURE OF THE PARENT / GUARDIAN SIGNATURE OF THE APPLICANT FOR OFFICE USE ONLY CERTIFICATES VERIFIED 1. PG Mark Statement 3. Community Certificate (Xerox Copy) 2. Transfer Certificate and Conduct Certificate 4. Special Category ADMITTED To M.Phil in ..................................... Checked by PRINCIPAL