Dravidian University
Srinivasa Vanam, Kuppam – 517 425
Admission Application
M. Phil / Ph. D / Post-Graduate / Five Year Integrated /
Under – Graduate / Diploma / Certificate Courses
2007-2008

Name of the Course Applied for   :                                                         __________________________________________

1.                                                     

Name of the Candidate            :                                                        

__________________________________________
       (In Capital letters)
2.Name of the Course     :                                                         __________________________________________

3.Name of the Father / Guardian :                                                         __________________________________________

4.Address for communication     :                                                         __________________________________________
                                                                                    
                                                                                                                      __________________________________________

                                                                    
                                                                                        PIN:
                                                                                                            
5.Date of Birth    :                                                                                                   
                                                        

6.Specify Gender (Tick the relevant box)                              :     Male   Female       

7.Category (Tick the relevant box) :  SC    ST    BC-A    BC-B    BC-C    BC-D OC                                     

8.Special Category (Tick the relevant box)  :   NCC   NSS   Sports   Games   PH   Ex-Servicemen

9.Enclose Xerox copies of the following Certificates:
       1. Transfer Certificate
       2. Conduct Certificate
       3. S.S.C & Intermediate Pass Certificates
       4. Degree Marks & Provisional Certificate
       5. Original Caste Certificate (Permanent or Latest obtained from the M.R.O/ Thahasildhar)
       6. Income Certificate (obtained in 2007 from the M.R.O / Thahasildhar)
       7. Relevant Certificate in case of Physically Handicapped   
       8. Relevant Certificate in case of NCC / NSS / Games & Sports  
       9. Discharge Certificate and Service Certificate in case of Children of Armed personnel 
      10.Migration Certificate (in case of other University Students)  

10.Particulars of Study and Marks obtained in Intermediate / Degree /P.G. / M. Phil.
              

11.Whether the Demand Draft Enclosed   :   Yes / No

      D D No:                                     Date:                                        Rs.

Declaration by the Candidate
                                                        
I declare that the particulars furnished are true to the best of my knowledge. If the particulars furnished by me are found to be false at any time I may be disqualified by the University and punished as per rules. I shall abide by the rules and regulations of the University.

Place:
Date:                                                                   Signature of the Candidate

Declaration by the Parent / Guardian
                                                         I declare that I shall undertake to see that my ward obey all the rules of the University and pay all fees to the University. If he fails to obey the rules of the University, I authorize the University authorities to take disciplinary action against my ward. 

Place:
Date:                                                      Signature of the Parent / Guardian