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471 SY ApplicationForm 2024-25

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46 views2 pages

471 SY ApplicationForm 2024-25

Uploaded by

gokularaj25
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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P.A.C.

RAMASAMY RAJA POLYTECHNIC COLLEGE,


(AUTONOMOUS INSTITUTION)
Kumarasamy Raja Nagar Post, 04563-235740
E-mail : [email protected]
RAJAPALAYAM - 626 108.
APPLICATION FORM FOR ADMISSION TO SECOND YEAR DIPLOMA COURSES 2024 -2025
Filled in application should be sent to The Principal, Registration No. :
Application No. P.A.C. Ramasamy Raja Polytechnic College,
Rajapalayam - 626 108. (To be assigned by office)

Last date for receipt of filled in application : one week from the Publication of 12
th
Result
Before filling the application, read the prospectus carefully.
H.Sc. ACADEMIC / VOCATIONAL TOTAL MARKS / 600

Affix
ITI TRADE TOTAL MARKS
Recent
1. Name of the Candidate :
(In Block Letters)
Passport
2. Address for Communication : Size
Photograph

Pin :

Mobile Number E-Mail ID

3. Sex Male Female Transgender 4. Date of Birth


Date Month Year
5. Religion HINDU ISLAM CHRISTIAN OTHERS /

ST SC SC MBC/DNC BC BC OC
6. Community (Arunthathiar) (Muslim)
(Put a tick mark in the appropriate box)

7. Name of the Community

8. Community Certificate No.

9. Aadhaar No.

10. Parent's Occupation

11. Parent's Annual Income

12. EMIS No.

13. Did you study VI, VII, VIII, IX & X Standard in Tamilnadu ?
VI VII VIII IX X
Yes No Yes No Yes No Yes No Yes No
Enclosures : ITI Candidates should submit a photo copy of 10th Mark Sheet, ITI Mark Sheet, Community
Certificate & Aadhaar Card along with the Application
14. Marks obtained in H.Sc./Equivalent Examination (False information will lead to cancellation of admission and Criminal Action)
HSC Academic Mark Marks Obtained Maximum Marks H.Sc. Vocational Marks Marks Obtained Maximum Marks

Part I Tamil or Language 100 Part I Tamil or Language 100

Part II English 100


Part II English 100
Part III Mathematics
Part II Mathematics 100 (any one
Physics 100
of the
Subject) Chemistry
Physics 100
Name of the Vocational Course
Chemistry 100 Theory 100

Practical - I 100
Elective 200
Practical - II 100
TOTAL 600
Total 600

15. Details of study during the last 3 years :


Sl. Month & Year of Name of the School
Class Register No.
No. Passing and Address

1 X Std.

2 XI Std.

3 H.Sc.

4 ITI

16. Nationality :

17. Place of Birth :

18. Name of Native District :


:
19. Mother Tongue
DECLARATION BY THE APPLICANT

I............................................. (Name in full) Son / Daughter of .................................................hereby


solemnly declare that the information furnished in the statements given in the application, and the
enclosures are true, correct and complete. I further declare that should it be found otherwise, I will be
liable to forfeit my seat and / or removal from the roll of the institution at whatever stage of study
besides making me liable for Criminal Prosecution.

Place :

Date : Signature of the Candidate


Enclosures : H.Sc. Candidates should submit a photo copy of +2 Mark Sheet, Community Certificate & Aadhaar Card
along with the Application.

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