Year: 2023 - 2024                                                                                                                 Form No:[For Office use only] Fields marked with are mandatory. *
Name : (In Block letters): *
Age & Date of Birth: *
Sex (Male/Female) :
Community (OC/BCM/BCC/BC/MBC/SCC/SC/ST): *
Nationality & Religion:
Mother Tongue:
Place of Birth:
Village/Town/City:
District:
State:
Name of Parents:
Father:
Mother:
Address with Pincode: *
Mobile:
Email: *
Name of Local Guardian:
Guardian Address:
Guardian Mobile:
Guardian Email:
Address for Communication:
Mobile: *
Email:
Occupation of Parent/ Guardian:
Annual Income : Rs	/ annum
Extra- Curricular Activities:
The name of Qualifying Examination Passed:
University/Board:
Marks Obtained in the Qualifying Examination HSC +1 or Equivalent
Regn No.
Date & Year of Passing
Subjects:
TAMIL:		Max.Mark:
ENGLISH:		Max.Mark:
MATHS:		Max.Mark:
PHYSICS:		Max.Mark:
CHEMISTRY:		Max.Mark:
BIOLOGY:		Max.Mark:
BOTANY:		Max.Mark:
ZOOLOGY:		Max.Mark:
TOTAL:		Max.Mark:
MAXIMUM MARKS:		Max.Mark:
Percentage:
Marks Obtained in the Qualifying Examination HSC +2 or Equivalent
Regn No.
Date & Year of Passing
Subjects:
TAMIL:		Max.Mark:
ENGLISH:		Max.Mark:
MATHS:		Max.Mark:
PHYSICS:		Max.Mark:
CHEMISTRY:		Max.Mark:
BIOLOGY:		Max.Mark:
BOTANY:		Max.Mark:
ZOOLOGY:		Max.Mark:
TOTAL:		Max.Mark:
MAXIMUM MARKS:		Max.Mark:
Percentage:

Pl. Note:
1. Applicants are expected to fill in the application form with the available data to register for their respective course and provide the remaining details later on.
2. Admissions will start as per the direction of Government and all the originals should be produced for the confirmation.
3. This Registration Acknowledgement will be sent by SMS to your Mobile.
4. For Enquiry : mob: 9094916711 & 9884215475