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Application Form - Distance

This document is an application form for examinations from Alagappa University's Distance Education program. It requests information from the applicant such as name, address, enrollment number, exam center, subjects appearing for, and exam fees payment details. The form also verifies that the applicant has paid course fees due to the university and lists the subjects the applicant will be appearing for in the exams.

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Vijay Xavier
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© Attribution Non-Commercial (BY-NC)
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Download as PDF, TXT or read online on Scribd
128 views

Application Form - Distance

This document is an application form for examinations from Alagappa University's Distance Education program. It requests information from the applicant such as name, address, enrollment number, exam center, subjects appearing for, and exam fees payment details. The form also verifies that the applicant has paid course fees due to the university and lists the subjects the applicant will be appearing for in the exams.

Uploaded by

Vijay Xavier
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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ALAGAPPA UNIVERSITY

(Accredited with ‘A’ Grade by NAAC)


KARAIKUDI – 630 003.TAMILNADU
DISTANCE EDUCATION
APPLICATION FOR EXAMINATIONS

1. Course : 2. Exam Centre with


Centre Code :
3. Name of the Study Centre : 4. Month & year of Exam :

1. Name of the applicant(in Block letters) :

2. Father’s Name :

3. Sex : M F

4. Enrolment No. :

5. Permanent Address with Pincode :

6. Year/Semester for which you are appearing


(Both Regular and Arrears) :

7. EXAMINATION FEES PAYMENT DETAILS Total


Details Nos Amount
Rs.
a) Amount paid : Rs. 1. Subject(s) fee

2. Practical(s) /
b) D.D. Number : Dissertation fee

c) Date of payment : 3. Certificate fee


(including Exam
d) Name and place of : Application fee,
issuing Bank Mark Statement fee,
Provisional
Certificate fee,
8. *Have your paid the course : Yes/No Degree Certificate
fees due to the University fee) to be paid only
during first
Station: appearance.
4. Late fee

Date: Total Rs.


Signature of the Candidate

Verified by:

CONTROLLER OF EXAMINATIONS
* Those who have not remitted Second / Third year Course fees will not be permitted to
appear for the examination
9. Subjects in which you are appearing

Title of the Paper


Subject FIRST YEAR / FIRST SEMESTER Subject FIRST YEAR / SECOND SEMESTER
Code Code

SECOND YEAR / THIRD SEMESTER SECOND YEAR / FOURTH SEMESTER

THIRD YEAR / FIFTH SEMESTER THIRD YEAR / SIXTH SEMESTER

Score out the letters and numerals which are not applicable to you

---------------------------------------------------------------------------------------------------------------------
ALAGAPPA UNIVERSITY
(Accredited with ‘A’ Grade by NAAC)
KARAIKUDI – 630 003
DISTANCE EDUCATION EXAMINATIONS, 200
HALL TICKET
(To be filled in by the candidate)
Name of the Candidate :
Photo to be
Course : affixed
Enrolment Number : here
Examination Centre :
SUBJECTS APPEARING (Write the subject code only)

Signature of the Candidate Controller of Examinations

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