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Sri Ramajayam Application No.

Application for AdmissDIRECTORATE OF DISTANCE EDUCATIONthe

Application for Admission to Various Programmes for the Calendar Year 2019
M.A.(Divyaprabhandam) M.A. (Sanskrit) M.B.A. M.C.A.

M.F.A.(Bharatanatyam)

B.Ed. B.B.A. B.C.A. B.A. (Vaishnavism)

B.F.A.(Bharatanatyam) Diploma in Sanskrit Diploma in Vishnu Sahasranamam

1. Applicant’s Name : ……………..............................................................................................

(as in Qualifying Examination mark sheet)
2 (a) Father’s Name
(b) Mother’s Name
(c) Husband’s Name (If Married)
: Shri .................................................................................... Applicant’s
Photo
: Smt .................................................................................... (Compulsory)
: Shri....................................................................................

3 Address for Communication : .......................................................................................

............................................................................................
............................................................................................
Pincode : ................ District :… ...................... State : Tamilnadu / Puducherry
Ph : ............................................Mobile No. : .............................................
Email ID :…………………………………………..

4. Sex : MALE FEMALE

Date Month Year Age as on :

5. Date of Birth :

6. Marital Status : Married Unmarried

7 (a). Nationality : ..................................... 7(b). Religion .....................................................

8 (a) Community : BC OBC MBC DNC SC ST OC

(b) Name of the Caste : ...........................................................................................................

9. Qualifying Examination Passed : ................................. (a) Month and Year of Passing : .......................
(b) Name & Address of the : ..............................................................................................................
College Studied .................................................................................................................
(c) Name of the Board /University : ….....................................................................................................
(d) Registration No(s). with Month
and year of Last Appearance : .................................................................................................................................

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 10. Educational Qualifications :

Year of Percentage of Marks /

Educational Qualifications Subjects University/Board
Passing Class & Grade

SSLC / X STD

PUC/H.Sc./Foundation
Course
D.T.Ed.

UG Degree
Additional
Qualifications/Any other
information

11. Teaching /Work Experience (Specify in chronological order)

Nature of Type of School

Organization Post/Designation held No.of
Name of the School/Organization with post Years
(Recognized) (PGT/TGT/Primary
Address (Temporary/ Private/Govt./Govt Teacher/Asst.Teacher/any other)
Permanent) . Aided

Total teaching experience : …………………………… (in completed years only)

TEACHING EXPERIENCE CERTIFICATE

(Compulsory for the applicants of the B.Ed. Programme)
(To be issued by the A.E.O./Principal/Headmaster/Headmistress of High School/Higher Secondary School/
Secretary of Aided School or any competent authority)

This is to certify that Dr.Mr./Ms. ……………………………………………….. has been teaching in this school
since …………………………………. As PG/Graduate/Primary/Nursery teacher and he/she is a full-time
teacher of this school. He / She has …………………… years of total teaching experience. This school is
Government/Government aided/unaided and duly recognized by the central or state government.

Place : ……………………………. Designation :……………………

Date : ……………………………… Address:…………………………

…………………………………..
Signature of A.E.O./Headmaster/Headmistress/
Principal/Secretary/Competent Authority

Name :……………………………. Office Seal :

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H ACADEMY
12. Details of Teaching /Working Experience (furnish the details in chronological order):
CE, & RESEARCH
Date of Service
Length of
S.No. Name of School/Organization Post Held
service in years
From To

Overall percentage of Part III subjects …………………………………………

Overall percentage in qualifying UG degree …………………………………...

GENERAL INSTRUCTIONS
1. The name you provide will appear identically on all official documents.
2. Indicate your permanent address. Your residential address is a stable one, which will be valid
for a long period of time. This is the address where you may be reached, even if your mailing
address changes. Indicate the phone number, residence and mobile number, fax and the email
address.

3. Indicate your qualifying examination passed, year of passing, registration number, number of
appearances and the marks secured in the qualifying examinations. Photocopies of the
individual Mark Sheets/Cumulative Mark Sheets, Provisional Certificate/ Degree
Certificate, and Transfer Certificate.

4. Fees once paid will not be refunded under any circumstances.

5. SASTRA reserves its right not to conduct a programme, if the response to that particular
programme is not adequate.

6. A recent passport size photograph duly attested by the Gazetted Officer be affixed on the
first page of the application.

7. Copies of certificates in support of Educational Qualification(s) for 10+2 and D.T.Ed./UG/PG

and experience certificate duly attested by the A.E.O./Principal/Head Master/
Headmistress/Competent Authority should be attached.

8. Proof of date of birth should be attached.

9. The Decision of the Director is final in the allotment of Study Centre.

10. SASTRA wishes that there be no dispute on any account. However if there is any dispute the
jurisdiction will be Thanjavur, Tamil Nadu and only through appropriate Forum. No third party
intervention will be entertained under any circumstances.

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 DECLARATION BY THE APPLICANT

I hereby declare that, I have read and understood the eligibility criteria for the Diploma
programme in Sri Vishnu Sahasranamam/Sanskrit/Under Graduate Programme B.Ed./BBA/
BCA/BFA(Bharatanatyam)/B.A.(Vaishnavism)/Post Graduate Programme M.B.A./ M.C.A./
M.A.(Sanskrit)/M.A.(Divyaprabandham)/M.F.A.(Bharatanatyam) for which I seek admission. I
fulfil the minimum eligibility criteria and I have provided necessary information in this regard in
the application form. I shall furnish the necessary proof of my eligibility for the programme I
accept the rules and regulations of the Institution and shall not raise any dispute in future about
rules. In the event of any information being found incorrect or misleading my candidature is
liable to be cancelled by the Institution at any time and shall NOT entitle me for refund of any
fee paid by me to the Institution. I accept the allotment of study centre by the Institution.

JOINT DECLARATION BY THE APPLICANT AND PARENT / GUARDIAN / HUSBAND

I hereby solemnly and sincerely affirm that the statement made and the information furnished
by me in the application as also in enclosures thereto submitted by me are true. Should it,
however, be found that any information furnished therein is untrue in material particulars or on
verification at a later stage, I am liable for criminal prosecution and I also agree to forego my seat
in this Institution / for the removal of my name from the rolls of the institution at whatever stage of
study I may be at the time of detection of such wrong particulars. I am also fully aware of the
general instructions and I am bound by the same.

Place :
Date : Signature of the Candidate

I am fully aware of the above declaration and I have understood the same. I agree to the above
conditions.

Place:
Date : Signature of the Parent / Guardian / Husband

Note: The guardian can execute the above declaration, only if both the parents are not alive.

SHANMUGHA TECHNOLOGY & RESEARCH ACADEMY

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 Directorate of Distance Education
STUDENT’S INDEX CARD

NAME OF THE PROGRAMME : Admission : 2019

Employee Identification No. Register No. (Office use only) :
(TO BE FILLED BY THE APPLICANT IN CAPITAL LETTERS)
Name : ....................................................................... Nationality : ..........................................
Sex : ........................................... Name of the Religion : ..........................................
Date of Birth :..........................................
Name of the Caste : ..........................................
Father’s Name : Shri......................................
Community : BC/OBC/MBC/DNC/SC/ST/OC
Mother’s Name : Smt ....................................
Husband Name(If Married) : .......................................... State : ..........................................
Guardian’s Name : Shri………………………………………... Relationship with student : ………….…………………………..
Occupation of Father / Guardian : Govt. Private Occupation of the Parent : Govt. Private
Name of the Organization : ........................................ Name of the Organization : .........................................
Designation : ........................................ Designation : ..........................................
Father/Guardian’s Annual Income : ...................................... Parent Annual Income : ........................................
Communication Address : .................................................................................................................................
.............................................................................................. Pin Code : ......................
Ph. No : With STD Code (Off) : ......................................... (Resi) : ................................................................
Mobile : ............................................., .............................................. E-mail ID : …………………………………………….
(Parent/Guardian/Husband) (Student)
Academic Details :
Qualifying Exam Passed:................................ Sch ool/University : ............................................

Institution Name:................................................................................................................................................

Register No. : ......................................................... Month & Year of Passing : .................................................

Overall Percentage : ............................................. Class obtained : ...................................................

Affix Affix
Student’s Parent Photo
Photo (Compulsory)
(Compulsory)

Signature of the Student Signature of the Parent /Husband/Guardian

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Received by Post / Person Enrolment No.

Date of Receipt of the Form

Eligible / Ineligible

Signature of the Administrative Director Signature of the Programme Director

with Date. with Date.

Note: Eligible Candidates will be invited to attend Counselling for Admission in the Main Campus of
SASTRA Deemed University at Tirumalaisamudram. The Date, Time of Counselling and fee structure will
be indicated in the Call letter.
• Cost of Application for Diploma is Rs.250/- (in person) and Rs.300/- if downloaded, with a
Demand Draft favouring SASTRA Deemed University, payable at Thanjavur.

• Cost of Application for Under Graduate is Rs.300/- (in person) and Rs.350/- if downloaded, with a
Demand Draft favouring SASTRA Deemed University, payable at Thanjavur.

• Cost of Application for Post Graduate is Rs.600/- (in person) and Rs.650/- if downloaded, with a
Demand Draft favouring SASTRA Deemed University, payable at Thanjavur.
Fee Details (per annum)

Programme Fees (Rs.)

Diploma in Vishnusahasranamam Free
Diploma in Sanskrit 3,000.00
Bachelor of Arts (Vaishnavism) 3,000.00
63,000.00
Bachelor of Education
(for two years)
Bachelor of Business Administration 10,000.00
Bachelor of Computer Application 15,000.00
Bachelor of Fine Arts (Bharatanatyam) 18,000.00
Master of Arts (Divyaprabandham) 4,500.00
Master of Arts (Sanskrit) 4,500.00
Master of Business Administration 20,000.00
Master of Computer Application 30,000.00
Master of Fine Arts (Bharatanatyam) 20,700.00

(A sum of Rs. 1,000/- will be collected as Admission Fee)

Last date for submission of filled in application form is 31-01-2019 (Thursday) 5.00 pm.

Completed forms must be mailed to – Directorate of Distance Education,

SASTRA Deemed University,
Tirumalaisamudram,
Thanjavur – 613 401.

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