KURINJI College of Arts and Science

APPLICATION FOR ADMISSION

MAJOR

NAME OF THE COLLEGE LAST STUDIED

NAME

DATE OF BIRTH

UG REGISTER NUMBER

QUALIFIYING EXAM PASSED

TOTAL MARKS IN UG

OUT OF

COMMUNITY

CASTE

RELIGION

NATIONALITY

SEX

Male Female

NAME OF THE PARENT / GAURDIAN WITH MOBILE NUMBER

ADDRESS OF COMMUNICATION

PINCODE

PHONE NUMBER

MAIL ID

IF PHYSICALLY HANDICAPPED, SPECIFY

YES NO

ARE YOU SON / DAUGHTER OF EX-SERVICEMAN OF TAMILNADU ORIGIN?

YES NO

DISTINCTION IN

SPORTS NCC NSS OTHERS

ANNUAL INCOME

HSC REGISTER No

MONTH & YEAR OF PASSING

Student Photo