KURINJI College of Arts and Science

APPLICATION FOR ADMISSION

MAJOR

PART I LANGUAGE

NAME

DATE OF BIRTH

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

NAME & LOCATION (DISTRICT) OF SCHOOL LAST STUDIED

ANNUAL INCOME

HSC REGISTER No

MONTH & YEAR OF PASSING

Student Photo

QUALIFYING EXAMINATION PASSED : HSC / EQUIVALENT