V.V. VANNIAPERUMAL COLLEGE FOR WOMEN (Autonomous)

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