APPLICATION NO.

ANNA UNIVERSITY OF TECHNOLOGY

Tiruchirappalli – 620 024
APPLICATION FOR ADMISSION TO M.E. DEGREE PROGRAMME
THROUGH
MODULAR BASED CREDIT BANKING SCHEME – 2011

Branch Applied for

1. Name: ________________________________
(in block letters with initials at the end)
Recent passport
2. Address for communication:
size photo attested
by the Head of the
Address
Institution

City Pin Code

Phone Number E-mail-Id

(with STD code)

3. Organization Details:

Organization Name

Address

City Pin Code

Phone Number E-mail-Id

(with STD code)

4. Academic Details:

Qualifying Discipline of the Date, Month Average

Name of the Name of the
Degree Qualifying and year % of
Institution University
Passed degree of passing Marks/Grade

(Attested copies of mark sheets, degree certificates, Experience certificates and Transfer
Certificate must be attached)
5. Professional Experience (Teaching / Research / Industrial) if any, after obtaining the qualifying
degree:

Sl. Name of the Institution Designation and Period of service Duration of service
No. Nature of work From To Years Months Days

(Note: Attach a separate sheet if the space provided is not sufficient)

Total No. of Months
6. Personal Details:
Date Month Year
Date of Birth : (as entered in SSLC (or) its equivalent)

Gender : Male Female

Nativity : Tamilnadu Other State

Nationality : Indian Foreigner

Father’s Name :

Community : Blood Group

7. Payment Details: DD.No. DD.Date: Name of the Bank:

All information submitted above are true to the best of my knowledge.

Place :

Date : Signature

Authorization Certificate from the Head of the Institution

This is to certify that --------------------------------------------- may be permitted to pursue his / her
M.E. degree programme through Modular Based Credit Banking Scheme offered by Anna University of
Technology Tiruchirappalli, Tiruchirappalli – 620 024

Place :

Date : Signature of the Head of the Institution with seal