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PUC_APPLICATION

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PUC_APPLICATION Powered By Docstoc
					       SHREE VARDHAMAN MAHAVEER JAIN EVENING P U
                      COLLEGE
            17th ‘C’ Cross, Indiranagar 2nd Stage, Bangalore – 560 038
                              (A UNIT OF S.H.S.S.)
     E-mail : smsgjaincollege@yahoo.co.in Website : www.smsgjaincollege.org

                                 APPLICATION FORM

Application No :                            Percentage obtained in the
                                            Qualifying exam
    (Tick the Relevant Box)
    Course Applied for I PUC                   Language Opted
                                                                          Affix Your Recent Passport
                                                                             size Photograph here
    Commerce
                                             Kannada
     HEBsA
                                             Hindi
    Arts
                                             Others specify
     HEPS                                    ……………………..

   1) Candidate’s Particulars
   a) Name (In Block Letters) …………………………………………………………………………………….
   b) Date of Birth ……...……………..          Place of Birth
       ….……………………… Nationality ………...……………...            Religion
       …………………………….…
      Tick if Jain
   c) Mother Tongue ……………………………………………………………...
   2) Name of the Parent / Guardian …………………………………………..….
   3) Occupation …………………….. Annual Income ………………………….

Applicant’s Permanent Address:                     Applicant’s Contact Address:
………………………………….                                    …………………………………….
………………………………….                                    …………………………………….
………………………………….                                    …………………………………….
………………………………….                                    ………………………………….…
Phone :               Mobile                         Phone :             Mobile

For SC / ST / BC Students only: Name of the Community ……………………
(Enclose attested copy of SC / ST / BC Certificate issued by the concerned authority)
Schled. Caste                        Schled. Tribe
Back. Comm.,                         Back. Caste
Back Tribe                           Spl. Group

Principal’s Observations
Admit to ……………………………         Language ………………………
Date of Admission ……………………. Date of Fees Payment
Special Remarks if any………………………………Principal

Name of the Institution last attended ……………………………………………..
Your Register No……………Name of the Exam Passed………….……………..
Month & Year of Passing …………………Medium of instruction …………….

                    Marks in the Qualifying Examination
Sl. No.            Subjects          Max. Marks      Marks Obtd.   No. of Attempts

  1.
  2.
  3.
  4.
  5.
  6.
                Total

Other information
Do you have a Brother or Sister studying in this College:   Yes          No.
If Yes specify: Name…………………….. Class …………………..
Have you registered for any Certificate or Diploma Course Yes            No.
(N.B. Students can not study P.U.C as well as Certificate or Diploma Course
Concurrently)
Co-Curricular activities: Specify your area of interest
     Sports                Cultural               Literary Others
1.
2.
3.
4.
Name of Prizes or Certificates won: 1. …………………………………………………
                                      2………………………………………………….
                                             Declaration
1. We have received the hand book
2. We have read and understood the rules and regulations mentioned in the application
   form and prospectus and the hand book. We promise to abide by them.


Signature of the Parent / Guardian:                                            Signature of the
applicant
Date :                                                                         Date :

Note : 1. The Applicant must fill this form in his / her own handwriting
       2. The Candidate’s local address should be written legibly on the envelop and adequate
          postage stamp should be affixed.
       3. The Declaration form duly filled in and signed must be submitted along with the
          application.
       4. Certificates, both original and true copies as mentioned in the prospectus to be
          Produced at the time of interview only.

				
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