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Admission Appication Form

This document is an application form for admission to various degree programs through the Periyar Institute of Distance Education at Periyar University. It collects basic applicant information like name, date of birth, address, occupation, previous educational qualifications. The applicant declares that the information provided is correct and agrees to abide by the rules and regulations of the Institute. Required enclosures include documents like transfer certificate, proof of date of birth, demand drafts, and copies of certificates. The form is to be filled by the applicant and submitted to the university for admission consideration.

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49 views1 page

Admission Appication Form

This document is an application form for admission to various degree programs through the Periyar Institute of Distance Education at Periyar University. It collects basic applicant information like name, date of birth, address, occupation, previous educational qualifications. The applicant declares that the information provided is correct and agrees to abide by the rules and regulations of the Institute. Required enclosures include documents like transfer certificate, proof of date of birth, demand drafts, and copies of certificates. The form is to be filled by the applicant and submitted to the university for admission consideration.

Uploaded by

srinivasana
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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For Office Use Only

Enrolment
Number

Application No : ___________

PERIYAR INSTITUTE OF DISTANCE EDUCATION,


PERIYAR UNIVERSITY, SALEM - 636 011.
Application for admission to B.A., / B.Sc., / BCA., / B.Com., /B.li., / M.A., / M.Com. / M.Sc. etc.
Certificate and Diploma Courses
Academic Year

Calenday Year

Year of Admission

Centre Code _______

Course to which Admission is sought ___________________________________________________________________________


Fee Particulars (to be Filled in by the candidate)

D.D. 1 Rs. ......................................

D.D. No ...................................... Date ................................

D.D. 2 Rs. ......................................

D.D. No ......................................

Date ................................

Name of the Bank ...............................................................................................................................


Place of the Bank ...............................................................................................................................

1. Name of Applicant (In English Capital Letters)

: ..................................................................................................

(In Tamil)

: ..................................................................................................

2. Name of the Father / Guardian / Husband

: ..................................................................................................

3. Name of the Mother

: ..................................................................................................

4. Date of Birth

: Date

Month :

Year :

5. Sex :

Male

Female

6. (a) Nationality : ..........................(b) Religion ............................................. (c) Community : OC / BC / MBC / SC / ST


7. Medium : Tamil / English

8. Physically Handicapped

9. Address to which Communication is to be sent :

10. Occupation :

_________________________________________________

(a) Employed

No

Yes

(b) Unemployed :

_________________________________________________
_________________________________________________
Pincode : ___________ District : _____________________ State : ________________________ Country :______________
Telephone / Cell No __________________________________
11. Previous Qualifications :

Course

School / College / University

Year of Passing

% of Marks

I hereby declare that the particulars given above are correct . I will a bide by Rules & Regulations of the PRIDE , Periyar
University.
Station

Date

Signature of the Candidate

Enclosures : (Tick the relevant boxes )


(1) Transfer Certificate

(2) Proof of Date of Birth

(4) Statement of Marks / Provisional Certificate / Degree Certificate

(3) No.of Demand Drafts


(Xerox copy of Certificate (s)
should be attested )

Office Use : Admitted / Not Admitted


Section.

Director.

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