Scribd
Upload
88 views2 pages

Annamalai University: Post Graduate Degree / P.G. Diploma in Health Science Programme 2013 - 2014

This document contains an application form for admission to postgraduate degree or diploma programs in health sciences at Annamalai University for the 2013-2014 academic year. The form requests information such as the applicant's personal details, educational qualifications, employment status, and a declaration agreeing to abide by the university's rules and regulations. It also lists the documents required to be enclosed with the application, such as degree certificates, mark lists, and age proof.

Uploaded by

Chithu Iniyan
Copyright
© Attribution Non-Commercial (BY-NC)
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
88 views2 pages

Annamalai University: Post Graduate Degree / P.G. Diploma in Health Science Programme 2013 - 2014

This document contains an application form for admission to postgraduate degree or diploma programs in health sciences at Annamalai University for the 2013-2014 academic year. The form requests information such as the applicant's personal details, educational qualifications, employment status, and a declaration agreeing to abide by the university's rules and regulations. It also lists the documents required to be enclosed with the application, such as degree certificates, mark lists, and age proof.

Uploaded by

Chithu Iniyan
Copyright
© Attribution Non-Commercial (BY-NC)
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
You are on page 1/ 2

ANNAMALAI UNIVERSITY

DIRECTORATE OF DISTANCE EDUCATION

APPLICATION NO.

SPOT CODE

Application for Admission to Post Graduate Degree / P.G. Diploma in Health Science Programme 2013 - 2014

FOR OFFICE USE ONLY ENROLMENT NO.

(REFER PROSPECTUS FOR DETAILS) (Make a tick-mark ( ) in square q wherever applicable) 1. Programme Code

2. Programme Name :

PASSPORT SIZE PHOTO duly signed and attested by an authorised officer

3. Name in CAPITAL LETTERS (in English):

4. Fathers Name / Husbands Name

5. ADDRESS IN CAPITAL LETTERS (to which communications and lessons are to be sent)

PIN Dist. State E-mail ID 6. Date of birth (in the Christian era) (as entered in the School Leaving Certificate) Date Phone No. (with STD Code) Mobile No. : Month 1 Year 9

7. Sex: Male

8. Nationality: Female qq Others (specify) Muslim q Christian q q ST MBC BC OC DNC

9. Religion: Hindu

10. Community to which the applicant belongs: SC 11. Qualifying Examination Passed: Duration of Name of the Programme Examination

Name of the University

Reg. No. and Year

Percentage Class of Marks Obtained

12. State the pattern under which passed the Degree Examination:

11+2+2

11+1+3 q 10+2+3 q 10+2+5 q q

Application Fee : ` 500/- in person and ` 590/- by post.

13. Are you employed? If yes, Occupation

Government

Non-Government q Others q q

14. No. of years of Service : 15. Are you presently undergoing any other programme, in any institution Yes (including DDE)? If yes, give details :

No q q

DECLARATION
i) I declare that the particulars given above are correct and I submit myself to the disciplinary and regularly jurisdiction of the authorities of the University who are vested with the rights to exercise discipline under the Act, the Statutes, and the Ordinances, and will strictly observe the rules and regulations that have been framed thereunder by the University. ii) I hereby agree that with regard to disputes arising in all matters including admission, returning of original certificates after verification, sending of lessons, PCPs, response sheets, examinations, remittance of fees, etc., only the Courts and Tribunals having jurisdiction over Annamalainagar (Chidambaram), Cuddalore District, Tamilnadu and not over any other place, shall have jurisdiction for the purpose of filing a suit or preferring complaint under the Consumer Protection Act or any other law for the time being in force or for taking any legal action against the Directorate of Distance Education or the Controller of Examinations, Annamalai University. iii) I am aware of the fact that the P.G. Degree/P.G. Diploma Programmes in Health Sciences offered by the D.D.E., Annamalai University do not come under the purview of the respective Councils and that the same cannot be registered as additional qualifications in the Registers of the Councils.

Place: Date:
Enclosures: (1) Degree/Provisional/Diploma Certificate
(Photostat Copy (3) Transfer/Migration/Any Age Proof Certificate Only)

Signature of the Applicant


(2) Marklist q (4) Identity Card duly filled-in q

(5) Permanent Registration Certificate in the respective Councils

(6) Scanning Slip

q q q

(Do not enclose Original Certificates)

FOR OFFICE USE ONLY

ELIGIBLE

NOT ELIGIBLE q q

REMITTANCE PARTICULARS CERTIFICATES VERIFIED AND RETURNED TO STUDENT ON ......................... 1) Degree/Provisional/Diploma Certificate Name of the Bank : q 2) Transfer/Migration/Any Age Proof Certificate Draft/Challan Number : q 3) Mark List Amount : q 4) Permanent Registration Certificate in the respective Councils

Date:

Provisionally selected for admission. Spot selection subject to confirmation by the Director

Official-in-Charge

Section Head For Spot Admission

Officer-in-charge

Whether Original Certificates No q received after verification? : Yes q

Whether PCP dates received during spot admission Yes q No q


Signature of the Candidate

Admission Confirmed

Official-in-Charge

Section Head

DIRECTOR

You might also like