TNEA 2023– APPLICATION REGISTRATION – PREPARATION DATA SHEET

I. REGISTRATION INFORMATION(é©z¥gjhuç‹ jftšfŸ)

Candidate’s Name(é©z¥gjhuç‹ bga®) (as per 12th Mark Sheet) : .......................................
E-mail ID / User ID (ä‹dŠršKftç–gadhs® F¿pL) : .......................................................
Mobile Number (miyngÁ v©): ....................
Date of Birth (Ãwªj njÂ):....../......./......Qualifying Examination (jF¤ nj®Î) : .....................
Whether +1 passed(+1 ேதர்ச் ெபற் க் ர்களா?): Yes/No
II. PERSONAL INFORMATION (Ra jftšfŸ)
Parent Name(bg‰nwh® bga®) : .............................................
Address (Kftç) :.................................................................................................
................................................................................................
State (khãy«): ..................... District (kht£l«): .....................................Taluk(t£l«):……………………
Pincode(mŠršF¿p£L v©).................................. Gender (ghèd«) : Male/Female/Transgender
Nationality ( ரிைம) : Indian / Srilankan Refugee / Others
Nativity (brhªj khãy«) :Tamil Nadu / Others Nativity Certificate Number(If applicable) : ...........
Native District (brhªj kht£l«) : .................................................
Civic Status of native place (brhªj C® Foikãiy) : ..................................................
Mother Tongue (jhŒbkhê): ..................... Religion (kj«): ..................................................
Community (tF¥ò) ST / SC/ SCA / MBC& DNC/ BC / BCM / Others
Caste name (rhÂ¥ bga®): ..................... Community Certificate Number (If applicable) : ....................
Aadhaar Number (é©z¥gjhuç‹ Mjh® v©) ............................
III. SPECIAL RESERVATION INFORMATION (Áw¥òÏlxJ¡ÑL jftšfŸ)
Eminent Sports Person (éisah£LÅu®) : Yes/No
Ward of Ex-service man (K‹dhŸ ÏuhQt Åu® kf‹/kfŸ) : Yes/No
Differently Abled Person (kh‰W¤ ÂwdhëfŸ) : Yes/No
If Yes, Differently Abled type (ஆம் எனில் , kh‰W¤ Âwdhë வைக) …………………….
Preferred Certificate Verification Centre (TFC)
(rh‹¿jœ rç gh®¡f éU¥gKŸs cjé ika«): ..........................................................
IV. SCHOLARSHIP INFORMATION (cjé¤ bjhif jftšfŸ)
Parent Occupation (bg‰nwhç‹ bjhêš) : ..................................................
Parent Annual Income (bg‰nwhç‹ M©L tUkhd«) : ..................................
First Graduate Tuition Fee Concession (Kjšg£ljhç cjé¤bjhif) : Yes/No
Post Matric Scholarship (SC/SCA/ST or SC/SCA Converted Christian ca® fšé¤ bjhif) :Yes/No
V. SCHOOL STUDY INFORMATION (gŸë¡ fšé ¤ jftšfŸ)
Whether candidate has studied 8th to 12thStd in Tamil Nadu
é©z¥gjhu® tF¥ò 8 Kjš 12 tiujäœeh£oš go¤jtuh? : Yes / No
Whether candidate has studied 6 to 12 Std in Government School(s)
th th

é©z¥gjhu® tF¥ò 6 Kjš 12 tiu அர பள் ளி ல் go¤jtuh? : Yes / No

Medium of Instruction (ப ற் ெமா ) : … … … … … … … … … … … … ..
Educational Management Information System(EMIS) Number : ………………………………….
(கல் ேமலாண்ைம தகவல் ைமய எண் )
Have you applied for NEET ?( NEET க் ண்ணப் த் க் ர்களா?) : Yes / No
Have you applied for JEE ?( JEE க் ண்ணப் த் க் ர்களா?) : Yes / No
Civic Status of School (gŸëæ‹ Foikãiy) : ..................................................
 Class Year of Passing State District Block Name of the
tF¥ò nj®¢Á bg‰w M©L khãy« kht£l« k©ly« School
gŸëæ‹ bga®
VI Std .............................. ............... ............................ .......................... .......................
VII Std .............................. ............... ............................ .......................... .......................
VIII Std .............................. ............... ............................ .......................... .......................
IX Std .............................. ............... ........................... .......................... .......................
X Std ............................. ............... ........................... .......................... ......................
XI Std ............................. ............... ............................ ............................. ......................
XII Std ............................ ............... ............................ ............................ .......................
VI. ACADEMIC INFORMATION ( fšé¤ jFÂjftšfŸ)
Marks Obtained in 10th(SSLC) Examination : .....................
Maximum Marks in 10th(SSLC) Examination :……………….
Marks Obtained in 12th(HSC) Examination : .....................
Maximum Marks in 12th(HSC) Examination :……………….
Qualifying Examination (jF¤ nj®Î) : .....................
Board of Examination (nj®ÎfŸ FGk«) : .....................
Passed the Qualifying Exam (jF¤ nj®éš nj®¢Á bg‰wtuh? ): Yes/No
Year of passing (nj®¢Á bg‰w M©L) : ............ Group Code (ghl¤bjhF¥ò v©): .....................

H.Sc (Academic) Registration No. Month & Year of Maximum Obtained

Subject (ghl«) gÂbt© Passing Marks Marks
nj®¢Á bg‰w khj«/ bgUk bg‰w
M©L kÂ¥bg© kÂ¥bg©

Overall Total ...................... .......................... ........................ .....................

Physics (P)- Ïa‰Ãaš ...................... .......................... ........................ .....................
Chemistry (C)-ntÂæaš ....................... ......................... ........................ .....................
Mathematics (M)-fâj« ....................... ...................... ........................ .....................
Total (P+C+M) ........................ ..................... ........................ ...................
Fourth Optional Subject
4tJ éU¥gghl« ...................... ..................... ....................... .....................

H.Sc (Vocational) RegistrationNo. Month & Year of Maximum Obtained

Subject (ghl«) gÂbt© Passing Marks Marks
nj®¢Á bg‰w khj«/ bgUk bg‰w
M©L kÂ¥bg© kÂ¥bg©

Overall Total ...................... .......................... ........................ .....................

Maths/Physics/Chemistry ....................... ....................... ..................... .....................
Vocational Theory ....................... ....................... ..................... .....................
Vocational Practical I ....................... ....................... ..................... .....................
Optional subject ....................... ....................... ..................... .....................
VII. PAYMENT OF REGISTRATION FEE (gÂΡ f£lzégu«)
Through internet Payment Gateway using Credit Card/ Debit Card/ UPI/Net banking-----------------------------
fl‹ m£il / g‰W m£il / UPI/Ïizajs¤Â‹ têf£lz« brY¤J Kiw
Through Demand Draft ( ேக காேசாைல வழியாக): --------------------------------------------