Estd : 1988

Shri Shambhulingeshwara Education Trust (R)

SRI SHAMBHULINGESHWARA COLLEGE OF

PHYSICAL EDUCATION
Affix Photo
Jayanthinagar, Pandavapura Taluk, Mandya Dist. Karnataka - 571 427

APPLICATION FOR ADMISSION TO B.P.Ed / M.P.Ed. COURSES

Admission No. : ......................................... Date :

Admission Sought to B.E.Pd./ M.P.Ed.

Session : 20 ....: 20.....

Student Details :

1. Name of the Applicant : ..............................................................................................................................

2. Date of Birth : Sex : Male Female :

3. Present Age : ......................................................... Blood Group : ....................................................

4. Nationality : .......................... State : .......................... Religion : ......................... Category : .......................

5. Aadhar Card No. : ........................................................ Annual Income : .....................................................

6. Maritial Status : .....................................Married : Un Married :

7. Contact No. : ........................................................

Parents Details :

8. Father Name : ...............................................................Occupation : .........................................................

9. Contact No. : .....................................................

10. Mother Name : ...............................................................Occupation : .........................................................

11. Contact No. : .....................................................

12. Spouse Name (If married) : ...........................................Occupation : .................................................

13. Contact No. : .....................................................

14. Permanent Address : Temporary Address :

...................................................................... ...................................................................

...................................................................... .............................................................

E-mail : ......................................................... Email : ..........................................

Academic Details :

17. Name of Previously Studied College : .............................................................................................................

18. Marks obtained at qualifying Examination i.e. B.P.Ed / Degree : ...................................

Sl Month &Year Max. Marks Grade/

Semester Name of the Subject
No. of Passing Marks Obtained %

2
3

4
5
6
7
8

Total

19. Proficiency in Sports & Game / Co-Curricular Activities / Other Achievements (if any) :
................................................................................................................................................................
................................................................................................................................................................

20. Check list of documents enclosed : Original Photo Copy

A. S.S.L.C / 10th Std. Certificate
B. PUC / 10+2 /12th Std. Certificate
C. Qualifying Examination (Graduation) Certificate
D. Caste & Income Certificate
E. Migration & Eligibility Certificate (Non Karnataka)
F. Medical Fitness Certificate
G. Sports Certificate
H. Passport Size Photos
I. Transfer Certificate
I do hereby undertake that the information given above is true to the best of my knowledge.
I here by undertake to abide by all the Conditions, Rules & Regulation at present and also those which
may be introduced here after by the Sri Shambhulingeshwara Education Trust (R) for the administration of the
Collge and Hostel, I am aware that the management has the full authority to expel me for negligence in studies
Or Misbehaviour. I will not indulge in any form of ragging.

Date :
Place : Signature of Parent / Guardian Signature of Apllicant

For Office Use only

Recommandation of Admission Committee ............................. Admitted / Rejected
Date of Admission : .............................

Officer Principal