AWH SPECIAL COLLEGE i
(AFFILIATED TO UNIVERSITY OF CALICUT) |
_ ‘SANCTIONED BY GOVT. OF KERALA tat
21/10, KALLAI P.O., CALICUT-673003 aoa
PHONE: 0495 - 2323526, 2325408, 2325250 |
No Es
Application for the Admission to B.Sc. Programme Under CUCBCSS 21 20...
T Choice T choice Ti chowe
Core Course Chosen
Common course chosen language | Mal/ Find (Select an
ther than English en oman
‘ieee cfm In English (in block letters)
Candidate ‘In mother tongue
2 Permanent Residence Aderess AdGress to which communications are tobe sent
Pin Ph Pin Ph
4. Sex Male/Female 5.Age 6. Date of ith
7. Place of Birth 8. Vilage / Town: 9 Tak
10, District 11 State 12. Nationality
13, Marta Status 14, Mother tongue
15, Name and Address of Parent/Guardian
5. Name and Address of Parent / Guardia naeiant
wath the applicant
ceupation
Pin Ph
16. Name and Adress of Local guardian —e
‘tthe appcant
Occupation
Pin Ph
ae
17. Name of Mother
7. Religion & Community
(Speaiy whetner SC ST /OEC /O8C)
18. Annual family income Re
20, Whether physically challenged? Ifyes, specify detaits |
i. Educational Qualficatons
{i) Name of the examination passed l (ii) Register No. and yee
{wy Optional subject studied
22. Detail of marks obtained in qualifying examinations
Pat ‘Subject ‘Marks obtained | Maximum Marks | Percentage
Total r
23. The Name and Address of the institution through which
the candidate presented for the qualifying examination
24. Name of the institution last studied & the University!
Board to which itis affliated
25. No. & Date of T.C
26. Whether a recipient of scholarship/fee concession?
if yes, specify details
DECLARATION
\ . : : hhereby declare that | have carefully read the conditions
for admission and that the information furnished are true. If admitted, | undertake to abide by the rules and regulations:
of the college and to actively participate in al the curricular and co-curricular programmes,
Place:
Date Name & Signature of the Applicant
DECLARATION
| hereby declare that | have known the financial obligation of my ward and | can afford to pay al the costs and undertake to pay the
tution and other fees payable on te tothe college as per the rules. | am aware thatthe fee once paid tothe college for admission
will not be refunded in case helshe does no join the course, he/she discontinues the studies, he /she is expelled from the college for
any reason and | ave io pay he fl fees fhe cance cscontinue te couse. lo stand hy he decaton gen toe colege
by my son / daughter / wa
Place:
Date Name & Signature of the Parent / Guardian
Aitested copies ofthe following Certificates to be attached For Ofice Use only
1. First page of SSL
2. Mark list of Qualifying Examination
3. Community Certificate in case of SC/STIOBC candidate
von ‘Admitted / Not admitted
Principal