Appln.No.

For Office use

ALAGAPPA UNIVERSITY ,KARAIKUDI-630 003

(A State University Accredited with A Grade by NAAC)

DIRECTORATE OF DISTANCE EDUCATION

(Recognised by Distance Education Council, New Delhi)

APPLICATION FOR ADMISSIONS [Semester System] for the ACADEMIC YEAR 2011-12
AFFIX STAMP SIZE PHOTO AND TO BE ATTESTED BY A GAZETTED OFFICER

To be filled in by the Learning Centre: Name of the Centre: Code No. Particulars of Demand Draft: D.D.No.__________________ Rs.__________ Date:____________Bank_____________________________ (To be filled in by the Candidate in his/her own handwriting in Block Letters) Course Applied for (Please put mark in the appropriate box)
MBA (General) MBA(International Business) MBA (Banking & Finance) MBA (Project. Management) MBA (Hospital Management) MBA (Logistic Management) MBA (Corp. Secretaryship) MBA (Tourism) MBA (Education Mgt.) MBA (HRM) MBA (Retail Management) MBA (Corporate Management) Note: The candidate should write his/her name on the reverse of the demand draft.

MBA (Technology Management) MBA (5 Years Integrated) MCA MCA (Lateral Entry) PGDCA M.S.W. (Master of Social Work)

Medium for MBA (General) (Please Tick) English letters):

Tamil

1. Name of the Applicant with initial (as in Qualifying Certificate in BLOCK

2. Fathers Name :

3. Address for Communication :

Pin code E-Mail ID:

Phone with STD Code :

Mobile:

4. Sex: 5. Community:

S C

S T

MB C

B C

O C

(Attach Community Certificate Xerox copy) Date Month Year 6. Date of Birth: 7. Nationality:

8. Details of Educational Qualifications: Course Studied Hr. Secondar y Under Graduate Post Graduate (Enclose Original and Attested copies of Plus Two/Hr. Secondary and UG/PG Provisional Certificate or Degree Certificate duly attested by Gazetted Officer.) Individual Mark Statements will not be accepted Option for MBA (General/ International Business): Electives for MBA (General): Marketin g Project Papers Name of the Degree Month & Year of Passing Name of the Institution/Colleg e/ University Percentage of Marks/ Class

Major

Finance

Personnel

System

I hereby declare that the particulars given above are true. If any of the particulars furnished are found to be false, I agree to forfeit my admission. Date: Signature of the Candidate

Note: The following documents must accompany the filled-in application : 1. Original and Copy of Hr. Secondary Mark Statement duly attested by Gazetted Officer. 2. Original and Copy of UG Provisional or Degree Certificate and Markstatement duly attested by Gazetted Officer. 3. Filled-in Student Index Card with stamp size photo affixed. 4. Demand Draft for Prescribed fee (Refer to Prospectus) 5. Copy of Community Certificate duly attested by Gazetted Officer (if applicable). Certified that

* Application is scrutinised Admitted / Not Admitted * Original Certificates are verified and returned * Copies of the certificates duly attested by Gazetted Officer are verified Date of Admission _________________ * Candidate is found eligible Signature of the Programme Officer with seal DIRECTOR Received back the original certificates:

Signature of the candidate

ALAGAPPA UNIVERSITY, KARAIKUDI-630 003.

(Accredited with A Grade by NAAC)

DIRECTORATE OF DISTANCE EDUCATION

(Recognised by Distance Education Council, New Delhi) STUDENT INDEX CARD

Appln. No:

Enrl.No:
PROGRAMME:__________________________________________________________

Stamp Size NAME:

Photo

DATE OF BIRTH:

ADDRESS: ______________________________________________

_____________________________________________ Signature of theStudent ______________________________________________

NAME OF THE STUDY CENTRE & PLACE