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P.G Application Form

This document is an application form for postgraduate courses at the Little Flower Institute of Social Sciences and Health. It requests information such as the applicant's name, date of birth, nationality, religion, caste, category, parents' names and occupations, address, contact details, education history, marks/grades obtained, and certificates earned. The applicant must declare that they will abide by the college rules and the application must be counter-signed by a parent or guardian.

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shahazad obaise
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120 views2 pages

P.G Application Form

This document is an application form for postgraduate courses at the Little Flower Institute of Social Sciences and Health. It requests information such as the applicant's name, date of birth, nationality, religion, caste, category, parents' names and occupations, address, contact details, education history, marks/grades obtained, and certificates earned. The applicant must declare that they will abide by the college rules and the application must be counter-signed by a parent or guardian.

Uploaded by

shahazad obaise
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Application No:

LITTLE FLOWER INSTITUTE OF SOCIAL SCIENCES AND HEALTH (LISSAH)


(Affiliated to the University of Calicut)
Kaithapoyil P O, Kozhikode – 673 586, Kerala, India
Tel. No. 0495-2232085, 2234129, 2232164 Mobile: 9400395500 Affix passport
www.lissah.com, email: mail.lissah@gmail.com size photo

APPLICATION FOR P.G Courses 20 __ 20__

MSW M. Sc Psychology M.Com MCJ

1. Name of the candidate in BLOCK LETTERS


2. Gender 3. Date of Birth
4. Nationality 5. Religion

6. Cast &Community
7. Category SC ST OBC OEC GENERAL
8. Name of Father/ Guardian Occupation of Father
9. Name of Mother Occupation of Mother
10. Annual Income 11. Blood Group

11. Permanent Home Address : Address for Communication

Pin code Taluk Pin code Taluk

Landline No: Parent’s Mobile No:


Candidate’s Mob. No:

12. Email. ID

13. Name of the institution last studied


and the university to which it is affiliated

14. Year of passing Reg. No TC .No:


15. Graduation B.A B. Sc B.Com BSW Others( )
University College Main Subject

Details of Marks/ Grade(Graduation) Marks obtained Percentage Grade CGPA

Part I – English

Part II – Additional Language

Part III – Core and Complimentary

Total for part I & III

Total for all the three parts

16. Certificate in Sports and Games/NCC/NSS if any :


(Enclose self attested true copies of testimonials)

17. Hostel Accommodation is required: Yes / No

DECLARATION

I ..................................................... hereby declare that all the details furnished above are correct
and that I shall abide by the rules and regulations of the college, and to do nothing either inside or
outside the college that will interfere with its orderly working, discipline and reputation.

Signature: Counter signed


Name & Signature of Parent/Guardian
Place:
Date:
FOR OFFICE USE ONLY

Course to which admitted: Admission No.


Date of Admission: Class No.

Principal

* Enclose self attested copies of SSLC, Plus Two & Degree Certificates with the application form
* Proof of SC/ST/OBC/OEC Community Certificate.
* Please see that full and accurate information is furnished against each of the column.

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