FACULTY OF SCIENCE AND HUMANITIES

Application Number

(to be allotted by the university) 1. PHOTOGRAPH

Paste your passport

Fill details in English using CAPITAL Letters size color photograph
Do not pin or staple
Read carefully the instructions fill details
Use black or blue Hi-Tech point for filling details
Mail the filled application to :
Director (Admissions), SRM University, SRM Nagar,
Kattankulathur 603 203, Kancheepuram Dt, Tamilnadu, india.

2. NAME OF THE APPLICANT

3. DATE OF BIRTH 4. GENDER

DATE MONTH YEAR MALE FEMALE

5. RELIGION 6. NATIONALITY

7. NAME OF THE PARENT / GUARDIAN

8. COMMUNITY 9. MOTHER TONGUE

General / OC OBC BC MBC SC ST

10. ADDRESS FOR CORRESPONDENCE (DO NOT REPEAT NAME)

11. CITY 12. STATE 13. PIN CODE

14. STD CODE 15. TELEPHONE NUMBER 16. MOBILE NUMBER

17. E-MAIL ADDRESS

1
18. PARENT’S INCOME (`)

Below 50,000 50,001 to 1,00,000 1,00,001 to 2,00,000 2,00,001 to 4,00,000 Above 4,00,000

19. PARENT’S OCCUPATION 20. MEDIUM OF INSTRUCTION

21. DETAILS - Xth AND XIIth STANDARDS

REGISTRATION MONTH /
SCHOOL EXAM SCHOOL BOARD (CODE) % OF MARKS
NUMBER YEAR OF PASSING

22. DETAILS OF QUALIFYING EXAMINATION FOR PG / PG DIPLOMA PROGRAMS

REGISTRATION MONTH /
EXAMINATION COLLEGE UNIVERSITY AGGREGATE % MARKS
NUMBER YEAR OF PASSING

23. HOSTEL REQUIRED 24. SPORTS ACHIEVEMENT(S)

YES NO STATE NATIONAL INTERNATIONAL NONE

25. PROGRAM APPLIED

B.A. B.B.A. B.C.A. B.Com B.Sc. B.Ed Diploma M.A. M.C.A M.Sc M.Ed M.Phil P.G.Diploma

26. BRANCH / SPECIALIZATION

27. PAYMENT OF APPLICATION FEE OF ` 750/- TO BE DRAWN IN FAVOUR OF ‘SRMIST’, PAYABLE AT CHENNAI

PAYMENT MODE NUMBER AMOUNT (`) DATE ISSUING BANK NAME BRANCH

BANK CHALLAN

DEMAND DRAFT

28. DECLARATION

I hereby declare that I have carefully read the instructions and particulars supplied to me and that the entries made in this application form
are correct to the best of my knowledge and belief. I note that the decision of the university is final in regard to selection for admission.
If selected for admission, I promise to abide by the rules and regulations of the University and the guidelines in the prospectus.
The University shall have the right to expel me from the University at any time after admission, provided it is satisfied that I was admitted on
false particulars furnished by me or my antecedents prove that my continuance in the university is not desirable. I agree that all disputes are
subject to the jurisdiction of the courts at Chennai only. Fees paid on counseling and admission will not be claimed back under any
circumstances.

SIGNATURE OF PARENT / GUARDIAN SIGNATURE OF APPLICANT DATE

2
 INSTRUCTIONS FOR FILLING APPLICATION

1. PHOTOGRAPH: Paste your most recent colour photograph in the given space. Do not stable or pin the photograph. The Applicant to
sign within the box below the photograph.

2. NAME OF THE APPLICANT: Write your name in CAPITAL LETTERS as it appears in your xth standard mark sheet. Leave one blank box
between adjacent words. Do not any prefixes like Dr., Mr., Mrs., Miss, Ms, etc. For example, MR. RAVI SUNDAR SINGH should be
written as:

R A V I S U N D A R S I N G H

3. DATE OF BIRTH: Enter the date, month and year of your birth as recorded in 10th standard mark sheet in DD/MM/YY format only.
For single digit numbers, zero should be prefixed. For example, 27th January 1993 should be written as:

4. GENDER: Tick the appropriate box.

MALE FEMALE

5. RELIGION: Fill up your religion. For example, if your religion is Hindu, it should be written as:

6. NATIONALITY: Write your nationality. For example, if you are an Indian, it should be written as:

7. NAME OF PARENT/GUARDIAN: Write the name of your parent or guardian.

For example, MR. SUDIR KUMAR SINGH should be written as:

8. SOCIAL STATUS / COMMUNITY: Fill your Social Status / Community. For example, if you belong to ‘OTHER CASTE’, tick as below:

GENERAL / OC OBC BC MBC SC ST

9. MOTHER TONGUE: Refer to the table below for codes. For example, if your mother tongue is Hindi, write as below:

LANGUAGE CODE LANGUAGE CODE

Assamese Oriya

Bengali Punjabi

Gujarati Rajasthani

Hindi Sindhi

Kannada Tamil

Kashmiri Telugu

Malayalam Urdu

Marathi Others
10. ADDRESS FOR CORRESPONDENCE: Write the complete postal address including PIN CODE to which communications to be sent.
Also write the telephone number with STD code and e-mail address, if any.

For example, the address,

MR. RAVI SUNDAR SINGH, S/O SUDIR KUMAR SINGH,
NEW No 20, OLD No 23, 2ND CROSS, INDIRA NAGAR, ADAYAR, CHENNAI 600020

ADDRESS FOR CORRESPONDENCE (DO NOT REPEAT NAME)

11.CITY: Fill in your city’s name. For example, the city ‘Chennai’ should be written as:

12.STATE: Refer to the table given below for state codes. For example, the state ‘Tamil Nadu’ should be written as:

STATE CODE STATE CODE

Andhra Pradesh Mizoram

Arunachal Pradesh Nagaland

Assam Orissa

Bihar Punjab

Chattisgarh Rajasthan

Delhi Sikkim

Goa Tamil Nadu

Gujarat Tripura

Haryana Uttar Pradesh

Himachal pradesh Uttaranchal

Jammu and Kashmir West Bengal

Jharkhand Andaman and Nicobar Islands (UT)

Karnataka Chadigarh (UT)

Kerala Dadra and Nagar Haveli (UT)

Madhya Pradesh Daman and Diu (UT)

Maharashtra Lakshadweep (UT)

Manipur Puducherry (UT)

Meghalaya

13. PINCODE: Fill up with the appropriate 6-digit Pin code. For example, the Pincode ‘600 020’ should be written as:

14. STD CODE: Fill up the STD code in the boxes provided. Use zero when prefixed to the STD code. For example, the STD code for
Chennai ‘044’ should be written as:
15. TELEPHONE NUMBER: Fill up your phone number in the boxes provided. For example, the telephone number ‘42022527’ should be
written as:

16. MOBILE NUMBER: Fill up your mobile in the boxes provided and do not prefix ‘0’ or leave any blank between numbers.
For example, the mobile number ‘99400 36049’ should be written as:

17.EMAIL ADDRESS: Fill up the email id in CAPITAL letters without blank spaces. For example, the e-mail id ‘ravisundarsingh@gmail.com'
should be written as:

18. PARENT’S INCOME (`):For example, if the parent’s income is 2,22,000, tick as:

Below 50,000 50,001 to 1,00,000 1,00,001 to 2,00,000 2,00,001 to 4,00,000 Above 4,00,000

19. PARENT / GUARDIAN OCCUPATION: Write the occupation of your parent. For example, if your parent is in Business,
it should be written as:

OCCUPATION CODE OCCUPATION CODE

GOVERNMENT SERVICES PROFESSION

I.A.S Engineer

I.P.S Doctor

I.F.S Chartered Accountant

SERVICE CATEGORY Lawyer

Army Agriculturalist

Air Force Artist

Navy Software

Police Consultant

Judiciary Teacher

Other Govt. Services Self Employed

PUBLIC SERVICE Other Private Sector

Minister, Central Govt. Business

Minister, State Govt. Others

MP

MLA

MLC

Member of Local Body

20. MEDIUM OF INSTRUCTION: If your medium of instruction is English, it should be written as:
21. DETAILS X AND XII STANDARD: Write the school / College, Board / University code, Registration No., Month and year of Passing and
aggregate percentage marks obtained in Xth standard / aggregate percentage marks obtained in PCM (Physics-Chemistry-Maths)/
PCB (Physics-Chemistry-Biology) in XII std or equivalent examination. In case the XII result has not been published, the marks obtained
should be sent on-line and mark sheet should be produced at the time of counseling. (Refer the table below, an example for Board /
University code)
For example , if you are from Church Park School, Tamil Nadu Board of Higher Secondary Education, passing XII standard in May 2011
with X standard score of 95%, it should be written as:
MONTH / YEAR OF
SCHOOL EXAM SCHOOL BOARD (CODE) REGISTRATION NO. % MARK
PASSING

XII CHURCH PARK

X CHURCH PARK

Name of Board Code

Andhra Pradesh Board of Intermediate Education
Assam Higher Secondary Education Council
Bihar Intermediate Education Council
Central Board of Secondary Education
Chattisgarh Madhyamik Shiksha Mandal
Council for the Indian School Certificate Examinations
Goa Board of Secondary and Higher Secondary Education
Gujarat Secondary and Higher Secondary Education
Haryana Board of Education
Himachal Pradesh Board of School Education
J & k State Board of School Education
Jharkhand Academy Council
Karnataka Board of Pre-university Education
Kerala Board of Public Examinations
Madhya Pradesh Board of Secondary Education
Maharashtra State Board of Secondary and Higher Secondary Education
Manipur Council of Higher Secondary Education
Meghalaya Board of Secondary Education
Mizoram Board of School Education
Nagaland Board of School Education
Orissa Council of Higher Secondary Education
Punjab School Education Board
Rajasthan Board of Secondary Education
Tamil Nadu Board of Higher Secondary Education
Tripura Board of Secondary Education
U.P. Board of High School & Intermediate Education
Uttaranchal Shiksha Evam Pariksha Parishad
West Bengal Council of Higher Secondary Education
Others

22. DETAILS OF QUALIFYING EXAMINATION FOR PG / PG DIPLOMA PROGRAMS: Write the name of the qualifying examination,
College, University, Registration No., Month and year of passing and percentage marks obtained. In case the result has not been
pulished, the marks obtained should be produced at the time of counseling. For example, an M.Sc., applicant should give B.Sc.,
details.
MONTH / YEAR OF
EXAMINATION COLLEGE UNIVERSITY REGISTRATION NO. AGGREGATE % MARK
PASSING

B.Sc., SRM Arts & Science College SRM University 687347 MAY 2011
23. HOSTEL REQUIREMENT: Tick ‘YES’ if you require an on-campus Hostel Accommodation.
For eg:

24. SPORTS ACHIEVEMENT(S): Write your sports achievement level. For example, if you had played at the ‘National Level’, tick the box as below:

25. PROGRAM APPLIED: Tick your preferred branch. For example, if an applicant is applying for B.Sc, tick the box as below:

26. BRANCH/SPECIALIZTION: For the Branch code, refer to the list given in pages 6 and 7. For example, if an applicant is applying
for B.Sc with Branch / Specialization ‘Biotechnology’, it should be written as:

27. PAYMENT OF APPLICATION FEE: For application fee of ` 750/-

a. BANK CHALLAN: Fill up the Number, Amount, Date, Issing Bank & Branchname. Also, write your name on the reverse
of the Challan.

b. DEMAND DRAFT: Fill up the DD number, Amount, Date, Issuing Bank & Branch name. Also, write your name on the reverse
of the DD.

28. DECLARATION: Applicants and the parent / Guardian must sign (with date) the declaration to authenticate the information provided
by them. Unsigned applications will not be accepted.

LAST DATE OF ACCEPTANCE: 15TH MAY, 2011

MAIL THE FILLED APPLICATION ALONG WITH A DD FOR ` 750/- TO

THE DIRECTOR (ADMISSIONS)

SRM UNIVERSITY
SRM NAGAR, KATTANKULATHUR 603 203,
KANCHEEPURAM DT, TAMIL NADU, INDIA.
E-MAIL: dir.admissions@srmuniv.ac.in
TEL: +91-44-2745 5715 / 3433 / 3788
+91-44-2745 2270 extn. 1451
FAX: +91-44-2745 3622
 (Reference for Item No. 26)

BRANCH/SPECIALIZATION CODE
FACULTY OF SCIENCE AND HUMANITIES
BACHELOR DEGREES CODE

B.A Econometrics

Journalism & Mass Communication

B.B.A. Bachelor of Business Administration

B.C.A. Bachelor of Computer Application

B.Com. Corporate Secretaryship

Bank Management

Marketing Management

Accounting & Finance

B.Sc Applied Mathematics

Bioinformatics

Biotechnology

Biotechnology & Bioinformatics

Computer Science and Technology

Computer Science

Film Technology

Hotel & Catering Management

Information Technology

Information & System Management

Visual Communication

B. Ed. Bachelor of Education

DIPLOMA COURSES

DHMCT Diploma in Hotel Management & Catering Technology

D.T. Ed Diploma in Teacher Education

D.F.A Diploma in Film Acting

 BRANCH/SPECIALIZATION CODE
FACULTY OF SCIENCE AND HUMANITIES
BACHELOR DEGREES CODE

MASTERS DEGREES

M.A Econometrics

Journalism & Mass Communication

International Relations

Public Administration

M.C.A Master of Computer Application

M.Sc Biotechnology

Bioinformatics

Computer Science and Tech.

Information Technology

Hotel & Catering Management

Applied Mathematics

Visual Communication

Biotechnology & Bioinformatics

Biotechnology & Bioinformatics (integrated)

Computer Science & Tech. (Integrated)

M. Ed. Master of Education

P.G.DIPLOMA COURSES

Journalism

Digital Library Management

M.Phill Computational Mathematics

Education