Annexure - 1

Dr. Mahalingam College of Engineering & Technology :: Pollachi 03

Application Form for Annual Day Arutchel ar A!ar" & #e$t %utgoing &tu"ent$ A!ar"

(Final year students only)

Department:''''' #ranch '''.. +. Per$onal Detail$ an" Aca"emic Detail$: S.No Name Roll No I Average - of marks in year II III IV Overall Remarks if any Final year ( &ection'''. Date: '') '') *0+,.

*.

Pa$$e" in Fir$t attempt ./e$ ) 0o.1 222222222 3f no4 mention the num5er of attempt an" no. of $u56ect$ 222222222222222222222222222

3. Atten"ance: Attendance " 1 ! # $ Semester % & ' ( )till now*

,. Participation4 Achie ement$ an" a!ar"$ in Cocurricular Acti itie$: .Dept. A$$ociation4 &7&4 &874 Clu5 &cience4 9o5otic$4 9ene!a5le Energy4 :ui;4 3&TE4 3EEE4 3&%34 &AE etc.1 S. No Name of the +oc,rric,lar Activities Details of Achievements awards Period of activities award Remarks if any

<. Participation4 Achie ement$ an" a!ar"$ in E=tracurricular Acti itie$: .Muthamil Man"ram4 Fine art$ clu54 0>F%4 /9C4 99C4 0&&4 0CC4 &port$ etc.1 S. No Name of the -.tra/ c,rric,lar Activities Details of Achievements awards Period of activities award Remarks if any

?. Any other achie ement$: .Paper pre$entation4 Pro6ect$4 E=ten$ion Acti itie$4 Placement etc.1 S. No Details of the activities Place in which awarded Period for which awarded Remarks if any

Page 1 !

@. 9epre$entation of College at &tate ) 0ational ) 3nternational >e el: S. No Details of the activities Place Period Details of Award

A. Contri5ution to the Department an" College: S. No Details of the activities +ontri0,tion 1eneficiary Period Remarks if any

B. Di" he ) $he a ail any $cholar$hip ) a!ar" from MCET or other$C ./e$ ) 0o1 : 2222222222 If yes2 3lease mention its detail Name of the S3onsor Amo,nt )in Rs.* Award Date 4 Remarks if any

+0. Any other rele ant information !ant to $pecify:

5his is to certify that the a0ove information are tr,e to 0est of my knowledge. Comment$ of PC Comment$ of DoD

&ignature4 0ame an" Date Page ! !

&ignature an" 0ame