For Office use

ALAGAPPA UNIVERSITY ,KARAIKUDI-630 003

(A State University Re-Accredited with A Grade by NAAC)

DIRECTORATE OF DISTANCE EDUCATION

(Recognised by Distance Education Council, New Delhi)

APPLICATION FOR ADMISSIONS [Semester System] for the CALENDAR YEAR 2012 AFFIX STAMP
To be filled in by the Learning Centre: Name of the Centre: Code No.

SIZE PHOTO AND SIGN IN THE BOX GIVEN BELOW

Signature of the Student

Particulars of Demand Draft: D.D.No.__________________ Rs.__________ Date:____________Bank_____________________________

Note: The candidate should write his/her name on the reverse of the demand draft.

(To be filled in by the Candidate in his/her own handwriting in Block Letters) Course Applied for (Please put mark in the appropriate box)
MBA (General) MBA(International Business) MBA (Banking & Finance) MBA (Project. Management) MBA (Hospital Management) MBA (Logistic Management) MBA (Corp. Secretaryship) MBA (Tourism) MBA (Education Mgt.) MBA (HRM) MBA (Retail Management) MBA (Corporate Management) MBA (Technology Management) MBA (5 Years Integrated) MCA MCA (Lateral Entry) PGDCA M.S.W. (Master of Social Work)

Medium for MBA (General) (Please Tick) English letters):

Tamil

1. Name of the Applicant with initial (as in Qualifying Certificate in BLOCK

2. Fathers Name : 3. Address for Communication :

Pin code

E-Mail ID:
Phone with STD Code :

Mobile:S

4. Sex:

5. Community: (Attach Community Certificate Xerox copy) Date Month Year

S C

S T

MB C

B C

O C

6. Date of Birth:

7. Nationality:

8. Details of Educational Qualifications: Cour se Studied Hr. Secondar y Under Graduate Post Graduate (Enclose Original and Attested copies of Plus Two/Hr. Secondary and UG/PG Provisional Certificate or Degree Certificate duly attested by Gazetted Officer.) Individual Mark Statements will not be accepted Option for MBA (General/ International Business): Electives for MBA (General): Marketin g Finance Personnel Papers System Name of the Degree Major Month & Year of Passing Name of the Institution/College / University Percentage of Marks/ Class

I hereby declare that the particulars given above are true. If any of the particulars furnished are found to be false, I agree to forfeit my admission. Date: Signature of the Candidate

Note: The following documents must accompany the filled-in application : 1. Original and Copy of Hr. Secondary Mark Statement duly attested by Gazetted Officer. 2. Original and Copy of UG Provisional or Degree Certificate and Markstatement duly attested by Gazetted Officer. 3. Filled-in Student Index Card with stamp size photo affixed. 4. Demand Draft for Prescribed fee (Refer to Prospectus) 5. Copy of Community Certificate duly attested by Gazetted Officer (if applicable). Certified that * Application is scrutinised Admitted * Original Certificates are verified and returned * Copies of the certificates duly attested by Gazetted Officer are verified Admission _________________ * Candidate is found eligible Admitted / Not Date of

ASST.REGISTRAR

Signature of the Programme Officer with seal DIRECTOR Received back the original certificates: Signature of the candidate

ALAGAPPA UNIVERSITY, KARAIKUDI-630 003.

DIRECTORATE OF DISTANCE EDUCATION
Council, New Delhi) STUDENT INDEX CARD (Re-Accredited with A Grade by NAAC) (Recognized by Distance Education

Appln. No: Enrl.No: PROGRAMME:_____________________________________

_____________________
NAME:
AFFIX STAMP SIZE PHOTO AND SIGN IN THE BOX GIVEN BELOW

DATE OF BIRTH :

Signature of the Student ADDRESS: ______________________________________________

____________________________________________ _____________________________________________
NAME OF THE LEARNING CENTRE & CENTRE CODE