Cost of Application : Rs.

300/-

Application No. Registration No.

KRISHNA UNIVERSITY
APPLICATION FOR SPOT ADMISSION INTO P.G. COURSES OF KRISHNA UNIVERSITY FOR THE ACADEMIC YEAR 2011-2012

MACHILIPATNAM 521 001

APPLICATION FORM
(To be filled by the Candidate)
Note: 1) Separate application is to be submitted for each course 2) The rank card of ANUCET-2011 shall be enclosed in case, the candidate appeared fro entrance examination

Affix Photograph

Course Name of the Entrance Exam/ Rank obtained, if applicable

1.

Subject

Name of the Application

(IN CAPITAL LETTERS)

2. Name of the Father/Guardian (Guardian if father is not alive) 3. Name of the Mother 4. Sex (Put a Mark) 5. Date of Birth 6. Residential Status (Put a Mark) 7. Reservation Category (Put a Mark) (if applicable) 8. Special Reservation category (Put a Mark) VH PH HI OH IN RDP NCC State C/GII B/GI IN SPORTS N IU CAP 1 2 3 4 Local ST SC Non-Local BC-A BC-C BC-D BC-E Male Female

Note : VH: Visually Handicapped, HI: Hearing Impaired, OH: Orthopedically Handicapped, IN: International N: National, RDP: Republic Day Parade, IU: Inter University, CAP: 1,2,3,4 indicate priorities as given in the certificate issued by District Sainik Welfare Officer

9. Details of the Qualifying Examination a) Examination Passed / Class obtained Name of the College Name of the University Year of Admission Months & Year of Passing Register No.

b) Subjects studied and marks obtained Sno Name of the Subject LANGUAGES i) ii) iii) iv) v) vi) vii) Viii) ix) x) xi) xii) xiii) 1) 2) 3) 4) 5) 6) Optional Subjects 1) 2) 3) Group Total Grand Total (iii + xiii)
Note: Students passed from Autonomous Institutions should enter marks excluding internal assessment marks

1 Year
Marks obtained Maximum Marks

II Year
Marks obtained Maximum Marks

III Year
Marks obtained Maximum Marks

First Language

English

Second Language : Language Total GROUP

11.Address for Communication (IN BLOCK LETTERS)

Pin Code 12. Phone No. STD Code: DECLARATION Phone: email:
I hereby solemnly affirm and state that the statements made and information furnished by me in this application from and also in the enclosures herein submitted by me are true and correct. I have not suppressed any information. However, if it is found that any information furnished herein is fraudulent, incorrect or untrue in material particulars, I realize that I am liable to criminal prosecution and also I agree to forego my admission. I am also fully aware of the rules, regulations and Instructions of the admissions. I further undertake to inform that if I get my selection under spot admission, I may not be entitled to get fee reimbursement from the university/ State Govt. and I will pay all the necessary fees prescribed by the university on my own for the stipulated period of the course.

Mobile:

Signature of Parent or Guardian

Signature of the Applicant

Place: Date:
FOR OFFICE USE ONLY
Rank Obtained/ Spot admission Reservation Category Admission Recommended /Rejected Subject Allotted to

Signature of the recommending authority

Signature of the admitting authority