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Application Form

The document is an application form for admission to the M.A. Degree course in Bharathanatyam & Rhythmology under private study at the University of Madras for the academic year 2021-2022, which requests information such as the applicant's personal details, educational qualifications, and enclosures of documents like age proof, mark sheets, and certificates.

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Neepur Garg
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177 views

Application Form

The document is an application form for admission to the M.A. Degree course in Bharathanatyam & Rhythmology under private study at the University of Madras for the academic year 2021-2022, which requests information such as the applicant's personal details, educational qualifications, and enclosures of documents like age proof, mark sheets, and certificates.

Uploaded by

Neepur Garg
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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UNIVERSITY OF MADRAS

Centenary Buildings, Chepauk, Chennai-600 005


(Established under the Act of Incorporation XXVII of 1857-
Madras Universit Act 1!"#$ %&tate Universit'
(hone()**$"5#!!*7#


Application for Admission to M.A., Degree course in Bharathanatyam & Rhythmology under
private study for the academic year 201!201"
###############################################
1. Programme to which admission is sought :

2. Department to which programme applied :

3. Name of the Applicant (in English) :

(in amil) :

!. Permanent Address ". Address for #ommunication

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

Pin code : $$$$$$$$$$$$$$$$$$$$$$$$$ Pin code : $$$$$$$$$$$$$$$$$$$$$$$$$$

%o"ile $$$$$$$$$$$$$$$$$$$$$$$$$$$$ %o"ile : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

&. Date of 'irth : Date : % %onth : (ear

). Name of *ather + ,us"and : $$$$$$$$$$$$$$$$$$$$$$$$$$$$ %other : $$$$$$$$$$$$$$$$$$$$$$$$$$$$

-. .e/ : %ale : *emale :

0. Nati1e .tate $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

2. Nationalit3 : 4ndian *oreign Nationals : $$$$$$$$$$$$$$$$$$$$$$$$$(.pecif3)

15. Name of the #ommunit3 : .#+. %'# ' '# : 6#

11. Ph3sicall3 #hallenged 'lind ,earing 4mpaired

6rthopaedicall3 ,andicapped

12. Num"er of 3ears studied in .chool and #ollege :
1572 8 12 3ears 157273 8 1& 3ears 117173 8 1&

15727372 8 1- 3ears 11717372 8



13. Details of 9ualif3ing e/amination for admission to the programme applied for :

,igher secondar3 + Pre :ni1ersit3 $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$


Degree+ P.;. Degree : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$


1!. Name of the 4nstitution+ #ollege and :ni1ersit3 where studied : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$

1&. Details of the 9ualif3ing e/aminations passed :





A
....<.#. or its
e9ui1alent
9ualification (i.e.
15
th
or 11
th

standard)
'
P:#+,..c.=+
4ntermediate Pre>
Degree + A4..# +
4.# or its
e9ui1alent
E/amination
#
'.A.=+'..c.= +
'.#om.=
D
Diploma in Dance
or an3 other
Diploma as
e9ui1alent
E/amination
(a)%ain .u"?ect
(")Name of the
.chool+ #ollege

(c) Name of the
'oard +
:ni1ersit3

(d) @egister No.
(e) %onth and
3ear of Passing

(f) Ahether
regular + 6pen
:ni1ersit3+
#orrespondence
.3stem of Pri1ate
stud3

(g) otal. No of
academic 3ears of
studies.

(h) Passed+
*ailed

(i)%a/imum
marBs prescri"ed

(?) otal marBs
.ecured

(B) Percentage of
marBs (C)


1). Enclosures (6riginals D Attested copies)

,.# #ertificate for proof of age #onduct #ertificate

.tate of %arBs Pro1isional Degree #ertificate

#ommunit3 #ertificate in case
of .#+.+%'#+'# Di Diploma in Dance

en 3ears of teaching + Performance + eaching D Performance (<etter should "e enclosed)

D$%&ARA'()* B+ ',$ A--&(%A*'

4 here"3 declare that the particulars furnished a"o1e are correct. 4 agree that the authorities ma3
in1alidate m3 application= at an3 time= if an3 of the information furnished is found to "e false.
4 am aware that m3 eligi"ilit3 for admission to a programme will "e decided "3 the concerned admitting
authorit3.

.ignature of the applicant.

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