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School OF Distance Education: Bharathiar University: Coimbatore - 46. Tamil Nadu, India

This document is an application for admission to Bharathiar University's School of Distance Education. It collects information such as the applicant's name, date of birth, address, contact details, course details, language preference, fee concession eligibility, education qualifications, and signature agreeing to abide by university rules. The bottom section is for office use, to verify the application and indicate admission approval or reason for rejection.

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Anu Sana
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306 views2 pages

School OF Distance Education: Bharathiar University: Coimbatore - 46. Tamil Nadu, India

This document is an application for admission to Bharathiar University's School of Distance Education. It collects information such as the applicant's name, date of birth, address, contact details, course details, language preference, fee concession eligibility, education qualifications, and signature agreeing to abide by university rules. The bottom section is for office use, to verify the application and indicate admission approval or reason for rejection.

Uploaded by

Anu Sana
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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SCHOOL OF DISTANCE EDUCATION

BHARATHIAR UNIVERSITY : COIMBATORE - 46. TAMIL NADU, INDIA.

APPLICATION FOR ADMISSION (NOT FOR CENTRES)

Enrol. No.
Application No.:
(For office use only)
[Application should be clearly filled-in with CAPITAL LETTERS by the candidate’s own handwriting in English. Please tick () where ever necessary]

Batch: ___________ Academic / Calendar Study Centre Code: TN0201

Name of the Centre: BHARATHIAR UNIVERSITY, ON-CAMPUS CENTRE, COIMBATORE

Course Name Major / Branch First Year Direct


Second Year Lateral Entry
Third Year Re-admission
[Not Applicable for First Year]

Name of the Candidate


As per the SSLC / HSC Record _______________________________________________________________
Date of Birth d d m m y y y y Sex: M F T
Affix a Recent
Name of the Father / Passport Size Photo
Mother / Guardian / Husband Here
__________________________________

Address ______________________________________________________ NO ATTESTATION

DON’T STABLE
______________________________________________________________
Applicant’s Specimen Signature
[inside BOX]
___________________________________Pin: _____________
1
District: __________________ State:_________________

Mobile:____________________ Phone:________________ 2
Email ID: _________________________________________
Part-I Language
(For UG only) Tamil Telugu Kannada Malayalam Hindi Urdu Arabic French

Graduates of Bharathiar University □


Concession claimed in
Teacher □ Police-Defense □ Physically
Tuition Fee:
Media-Press □ Ex-service men □ Challenged □ Women □
if applicable
please tick ()
[25%] [100%] [10%]

Fee Payment Particulars


Mode Number Date Amount Bank & Branch For office use only
DD
dd/mm/yyyy
Challan

DD
dd/mm/yyyy
Challan
Nationality: __________________ Religion: ___________________________
Community: SC SC(A) ST MBC DNC BC BC(M) OBC General

Are you already registered with (Regular/SDE) Bharathiar University? Yes No

If yes, Name of the course ______________________ Register No.:_________________


Elective /optional papers opted (Refer the course contents in the prospectus for elective / optional papers )
1. __________________________________ 2. _______________________________________

Qualifying examination passed (10+2+3/11+1+3/10+3+2/ others specify _________________)


Sl. Examination Course Subject / Year of % of
Board / University Register No.
No. Passed Name Major passing Marks

1. SSLC ***** *****


H.Sc./ PUC / Pre-
2. *****
Degree

3. Diploma

4. UG

5. PG / PG Diploma

I, ___________________________________________________________________ hereby
declare that the particulars given above are correct. I abide by the rules and regulations of the Bharathiar
University. If any particulars given are found to be incorrect at any point of time, I will abide by the
decisions of the University.
Note: Admission to the course is purely provisional and the University reserves the right to withdraw the course at
any time due to administrative reasons.

Place:________________
Date:_________________ Signature of the Applicant

For Office use only


Educationally qualified Yes No Concession Applicable Yes / No
Required certificates attached Yes No Total Amount Paid Rs. ____________
Original certificates verified Yes No Balance Amount Paid Rs. ____________
Admitted: Yes on ____________ No Reason_____________________________

ASO SO AR DR DIRECTOR

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