Application No.

SRI CHANDRASEKHARENDRA SARASWATHI VISWA MAHAVIDYALAYA

Enathur, Kanchipuram - 631 561, Tamilnadu.
(Declared as Deemed to be University u/s 3 of UGC Act 1956 vide notification No. F.9-9/92-U3 dated 26 May 1993 of the GOI)

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APPLICATION FORM FOR ADMISSION - UG COURSES

Name of the Candidate : ................................................................................................................... (as per Secondary School Certificate) Course Applied : .......................................................................................................................

Full Time / Lateral / Part - Time : ................................................................................................................ SECTION I - PERSONAL DETAILS

1. 2. 3. 4. 5. Name (in capital letters as recorded in Secondary school certificate) Date of Birth (DD/MM/YYYY) Age (as on 01.07.2012) * Sex (M / F) Nationality Name of Father / Guardian Occupation Annual Income 6. Mothers Name Occupation Annual Income Mother Tongue Religion Community (OC / BC / MBC / SC / ST) a Address for Correspondence Door No. & Street Town District & State PIN Telephone No. with STD Code Mobile No. of the Parent E-mail Permanent Address Door No. & Street Town District & State PIN Telephone No. with STD Code

7. 8. 9. 10.

11. 12.

* Maximum age limit for BE/B.Tech (Full Time) courses is 20 years Proof to be attached for all categories other than OC

SECTION II - ACADEMIC BACKGROUND

12. Class / Degree SSC / X Std Educational Qualifications (Fill the appropriate columns only) Board / University Month & Year of Passing Overall Grade with Medium of Instruction Percentage

Intermediate / HSC / ISC Diploma (Enclose Two Copies of Mark Sheets & Certificates, Transfer and Conduct Certificates) 13. Marks at the Qualifying Examination for B.E. (Full Time) courses only (Intermediate / HSC / ISC) Max.Marks Including Practical Marks Obtained Month & Year of Passing

Subject Mathematics Physics Chemistry

14.

Rank / Score in AIEEE / GATE / Any National : or State level Entrance Examination (Enclose Copy of the Rank Card) Are you otherwise abled applicant ? (If yes, Enclose Authorized Certificate) : Yes / No

15.

16.

Choice of the Branch in B.E. / B.Tech., (Mention three preferences) a) b) c) : NCC / NSS / Sports / Others Organizing Authority Month & Year Level (State / National / International)

17.

Extra Curricular Activities Name of the Sports Event Award Won

DECLARATION BY THE CANDIDATE I certify that all information submitted for the admission process including the application, personal and any other supporting materials are factually true, and honestly presented. I understand that I may be, subject to a range of possible disciplinary actions, including admission revocation or expulsion, if the information is found to be false. I shall abide by the code of conduct formulated by the university from time to time and the decision of the university authorities in all such matters shall be final and binding on me. Place : Date : Signature of the Candidate

DECLARATION BY THE PARENT I, Mr/Mrs............................................................................................................................. do hereby guarantee that my son / daughter / ward .......................................................... if given admission for the course applied in Sri Chandrasekharendra Saraswathi Viswa Mahavidyalaya, will not take part in any activity prejudicial to the interests of the institution. I vouch for his / her good behaviour and conduct during the entire course of studies. If he / she violates any of the rules and regulations of Viswa Mahavidyalaya, my son / daughter / ward and I shall abide by any disciplinary action, which may be taken by the university authorities. The decision of the authorities in this respect shall be the final and binding on us.

Photograph of the Parent / Guardian

Place : Date : Signature of the Parent / Guardian

CHECK LIST OF ENCLOSURES

* Name (As per SSC Record) * Proof of Date of Birth * Recently taken Photographs - 3 Passport Size * Photographs of Parents / Guardian - 1 Passport Size * Photocopies of * Community Certificate - 2 Nos * Mark Sheets of SSC, HSC, Degree / Diploma / P.G.Degree / M.Phil. (as applicable) - 2 Nos * Transfer Certificate - 2 Nos * Rank / Score card in Entrance Examinations like AIEEE/GATE etc. - 2 Nos * Authorized certificate in case of otherwise abled applicants - 2 Nos * Certificates of achievements in Sports - 2 Nos

INSTRUCTIONS
1. Duly filled in applications should reach The Registrar, SCSVMV University on or before the last date. 2. For applications downloaded from the universitys website, please quote the application number given at the time of downloading and fill it in the relevant places without fail. 3. Filled in downloaded applications must be sent to the following address along with the application fees in the form of Demand Draft in favouring of The Registrar, SCSVMV University, payable at Chennai. Address
The Registrar Sri Chandrasekharendra Saraswathi Viswa Mahavidyalaya Enathur, Kanchipuram - 631 561, Tamilnadu. Ph : 044-27264179 / Mob : 9443708720

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