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BHARATH INSTITUTE OF SCIENCE & TECHNOLOGY

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					                    BHARATH INSTITUTE OF SCIENCE & TECHNOLOGY
                       173, AGHARAM ROAD, SELAIYUR, CHENNAI – 600 073
                              TEL : 22229 0247 / 2229 0742 / 2229 0125
                                       www.bharathuniv.ac.in




APPLICATION FOR
ADMISISON TO
B.TECH / M.TECH /                                                PHOTO
Ph.D / MBA / MCA
M.S Courses




1. NAME (IN BLOCK LETTERS) : ………………………………………………………

2. DATE OF BIRTH              : ………………………………………………………

3. FATHER / GUARDIAN NAME : ……………………………………………………...

4. FULL POSTAL ADDRESS      :………………………………………………………
   WITH PINCODE & PHONE NO :……………………………………………………....
                             ………………………………………………………

5. ADDRESS FOR COMMUNICATION …………………………………………………..
   WITH PHONE NO. :          ………………………………………………….
                             ………………………………………………….


6. LAST EXAMINATION PASSED         ………………………………………………….


7. NAME OF SCHOOL / COLLEGE    ……………………………………………….....
   LAST ATTENDED WITH ADDRESS :………………………………………………….
MARK LIST-PARTICULARS OF QUALIFYING EXAMINATION

                           MARKS       MAX       YEAR     NO. OF
 S.NO.    SUBJECT
                          OBTAINED    MARKS    & MONTH   ATTEMPTS




 8. MOTHER TONGUE                :

 9. MEDIUM OF INSTRUCTION        :

 10. NATIONALITY                 :

 11. RELIGION & COMMUNITY        :
   (ENCLOSE ONLY PHOTOCOPIES         OC   BC    MBC      SC   ST
    OF CERTIFICATES)

 12. EXTRA CURRICULAR ACTIVITIES :
                            DECLARATION

I HEREBY SOLEMNLY ASSURE THAT THE PARTICULARS GIVEN ABOVE ARE TRUE TO
THE BEST OF MY KNOWLEDGE AND CONSCIENCE. I SHALL ABIDE BY THE CODE OF
CONDUCT FORMULATED BY THE UNIVERSITY FROM TIME TO TIME AND THE
DECISION OF THE UNIVERSITY AUTHORITIES SHALL BE FINAL.


PLACE :
DATE   :                                         SIGNATURE OF THE APPLICANT


              DECLARATION BY THE PARENT / GUARDIAN


I, MR / MRS. …………………………………………………………. DO HEREBY GUARANTEE

THAT MY SON / DAUGHTER / WARD, ……………………………………………………………..,

ADMITTED TO THIS COURSE WILL NOT TAKE PART IN ANY ACTIVITY PREJUDICIAL TO

THE INTEREST OF THE INSTITUTION.



I WILL STAND FOR HIS/HER GOOD BEHAVIOUR AND CONDUCT DURING THE COURSE

OF HIS/HER STUDY. IF HE/SHE VIOLATES ANY OF THE RULES/REGULATIONS I SHALL

ABIDE BY ANY DISCIPLINARY ACTION, TAKEN BY THE COLLEGE. THE DECISION OF

THE AUTHORITIES IN THIS RESPECT WILL BE FINAL.



I AGREE TO SIGN THE PRESCRIBED BOND IN THE EVENT OF SELECTION OF MY SON /
DAUGHTER / WARD.


PLACE :
DATE   :                                    SIGNATURE OF PARENT / GUARDIAN
                                 For Office Use Only


APPLICATION RECEIVED ON           :


INTERVIEW CARD SENT ON            :


ONLY PHOTOCOPIES OF CERTIFICATES TO BE ENCLOSED




NOTE : PLEASE SEND A SELF-ADDRESSED LONG SIZE ENVELOPE WITH A SIX-RUPEE
STAMP AFFIXED FOR SENDING INTERVIEW CARD.


MR. / MRS ……………………………………………………. IS REQUIRED TO APPEAR FOR A
WRITTEN TEST/INTERVIEW ON ………………………..…..............................................   AT
…...…………………………………………........... NO POSTPONEMENT OF DATE IS POSSIBLE.
ALL ORIGINALS SHOULD BE PRODUCED FOR PERUSAL AT THE TIME OF INTERVIEW.




                                                                  VICE – CHANCELLOR
                                                                BHARATH UNIVERSITY

				
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