Amritapuri Campus APPLICATION FORM FOR ADMISSION TO PROGRAMMES FOR THE ACADEMIC YEAR

Transcription

1 Amritapuri Campus APPLICATION FORM FOR ADMISSION TO PROGRAMMES FOR THE ACADEMIC YEAR ) Name of the candidate as in 12 th class certificate (Leave a blank space between name and initials) Gender: (Male/Female): Blood Group Date of birth: (dd-mm-yyyy) Native Place District: State: Mother Tongue: Nationality: Paste your latest color photograph here. Religion: Caste: Community*: SC, ST, MBC, BC, OBC/OEC / Others (to enclose Certificate) *(If the community certificate is in vernacular, English version of the same duly attested by the Notary Public of the locality to be attached) 2) Address for communication: (in CAPITAL LETTERS) P.O: Taluk: District: State: PIN code: Phone No.: (with STD code) Mobile: ) Permanent address: (in CAPITAL LETTERS) P.O: Taluk: District: State: PIN Code: Phone No.: (with STD code)

2 4) Father s name (Leave a blank space between name and initials) Date of birth: Age: Occupation: Annual Income: Office Address: (if applicable) P.O Taluk: District: State: PIN Code: Phone No: (with STD code) Mobile: ) Mother s name in CAPITAL LETTERS (Leave a blank space between name and initials) Date of birth: Age: Occupation: Annual Income: Office Address: (if applicable) P.O Taluk District: State: PIN Code: Phone No: (with STD code) Mobile: ) Name and address of local guardian (if any): P.O District: State: PIN Code Phone No. STD code Mobile: Relationship with the student: ) Academic details:

3 a) Particulars of qualifying examination (+ 2 or equivalent): Name of the examination: Board / University: Medium of Instruction Address of the School/Institution: Name: Street: Location: Town: District: P.O : State : Month & year of passing: Number of attempts: Subjects Marks obtained Max. Marks % of marks Subjects other than above Marks obtained Max. Marks % of marks b) Particulars of 10 th standard exam: Year of passing: % of marks obtained: ) Any higher studies after +2 ; If yes, please mention: Name of course: Board/University: Name and place of School/Institution: Month & year of passing: No. and date of Transfer Certificate: ) Amrita Entrance Examination 2016 : Registration Number : 10) ASA Programme in which admitted :

4 Campus : 11) Achievements in Extra Curricular activities etc. 12) How did you come to know about AMRITA? 13) Why are you choosing AMRITA for your studies? 14) (a). DECLARATION I, Son / Daughter of hereby declare that the particulars given by me in the application are true. I shall produce the original certificates at the time of admission or on demand. If, in future, any information is found to have been furnished falsely or incorrectly or any information suppressed to secure admission, I shall withdraw from the course without any claim or consideration. I further state that I have read the Instructions attached to the application form, before filling the application. Place : Date : Signature of the Applicant Name: 14 (b). DECLARATION BY PARENT/GUARDIAN I, undertake the responsibility of my son/ daughter/ ward who is seeking admission in Amrita Vishwa Vidyapeetham and declare that the information furnished by him/her is correct and true and that if in future, any information is found to have been furnished falsely or incorrectly or any information suppressed to secure admission, I shall withdraw my son/daughter from the course without any claim or consideration of the period of study/stage of the course he/she has completed. I further state that I have ensured that the candidate has read and understood the contents of Instructions attached to the application form, before filling the same. Place : Date : (Signature of the Parent/Guardian) Name:

5 Form No.3 (CERTIFICATE OF PHYSICAL FITNESS) (To be issued by a Registered Medical Practitioner not below the rank of a Civil Surgeon paid or honorary) I do hereby certify that I have examined Mr. / Ms. S/o. / D/o. Sri a candidate selected for admission to Amrita School of Arts& Sciences, Amrita Vishwa Vidyapeetham and cannot discover that he/she has any disease communicable or otherwise constitutional affliction or bodily infirmity except and I do not consider this a disqualification for undergoing the course of Engineering. His/her age, by appearance and according to his/her own statement is : He/she has marks of small pox vaccination : Yes / No Personal marks of identification: (1) (2) a. Height: b. Weight: c. Chest measurement on full inspiration: expiration: d. Acuteness of vision: In case where sight is corrected with Glasses the strength of glass for each eye. Left : Right : N.B. : Any deformities or other disabilities present should be noted in details. Signature of the Medical Practitioner : Name (In Block letters) : Registration Number : Designation : Station : Date :

6 AMRITAPURI CAMPUS JOINT DECLARATION BY THE PARENT / GUARDIAN AND THE CANDIDATE Name of the Candidate: Registration Number : Name of Father : I hereby solemnly and sincerely affirm 1. that the statement made and information furnished in my son s/daughter s/ward s application as also in all the enclosures thereto submitted by him/her are true. Should it however be found that any information furnished therein is untrue in particulars, I realize that we are liable to criminal prosecution and also agree to the forfeiture of his/her admission in the Institution. 2. that my son/daughter/ward would fully devote himself/herself to the studies and would not indulge in any activity affecting the conducive atmosphere in the campus. He/she would conform strictly to all the rules and regulations in force from time to time and that I realize that any breach of discipline and rules on my son s/daughter s/ward s part would entail his/her expulsion from the Institution. 3. that we are aware that at Amrita, a student is expected to attend 100% of the classes; but to accommodate possible exigencies like ill health, leave of absence may be permitted within specified limits, provided leave is applied for with proper certification of the cause of absence, and sanctioned by the authorities before the absence and that, students falling short of minimum required attendance are not permitted to appear for the end-semester examination. 4. that at the end of any semester a candidate has to earn the minimum prescribed Credits, to move to the next semester. 5. that we are aware that the curriculum for the various courses is not rigid and that any revision or modification made in the curriculum and syllabi during the course of his/her study in the Institution will be binding on him/her. 6. that in case of my son s/daughter s/ward s progress in studies being uniformly poor in the Institution his/her studies are liable to be terminated by the issue of Transfer Certificate. 7. that I am aware that if my son/daughter/ward is admitted into the hostel, he/she will strictly abide by the rules and regulations in force in the hostels and that any breach of discipline or rules or any unruly conduct or undesirable activities will be summarily dealt with by expulsion from the hostel and the Institute in addition to such other disciplinary proceedings that may be taken against him/her. 8. I have understood the implications of ragging and a separate joint declaration in this regard is submitted herewith. I shall share any information in this regard with the institutional authorities for eradicating the menace of ragging. 9. that use of cell phone is banned in the academic premises. SIGNATURE OF PARENT/ GUARDIAN DATE: ETTIMADAI, COIMBATORE. SIGNATURE OF CANDIDATE

7 AMRITAPURI CAMPUS Dear Parent, The Supreme Court of India, UGC, Governments of Tamil Nadu and other states have recommended very stringent measures to prevent Ragging in Educational Institutions. According to these recommendations, any student found to be guilty of involvement in any act of Ragging will be summarily dismissed from the Institution with a remark in his Transfer Certificate to that Effect. Wherever necessary, the matter may also be referred to the Police. Ragging includes tormenting others by words or deed, playing rough jokes on other, engaging in rough play, physical assault or threat, use of physical force, verbal abuse and aggression, exhibiting indecent gestures and obscene behavior, exposing fellow students and others to ridicule and contempt, violating the status, dignity, and honour of fellow students and others, violating the privacy and rights of others, and hassling or exhibiting riotous behavior. In the light of the above, as per recommendations of the Supreme Court, an annual joint declaration by the parent and the student is mandatory for the student to be enrolled for the classes. Kindly arrange to sign the declaration below after clearly understanding the implications and pass it on to the Institution when the student reports for joining the any programme. Name of the Student: Application / Registration No. JOINT DECLARATION BY STUDENT AND PARENT AGAINST RAGGING. Chairman, Admission Committee I, father/guardian of Mr./Ms. Reg. No. execute this declaration jointly with my ward. We have understood the serious implications of the involvement of my ward in any act, big or small, of Ragging which may cause disturbance to a fellow student. We have understood that the student under such instance will be liable for summary expulsion from the Institution, with a note in his TC to that effect and the case may also be referred to the Police. In such cases, the student will not be able to continue his / her studies not only in this Institution but also in any other Institution. We hereby declare that I as father/guardian shall properly counsel my ward against involvement in any such acts and if his/her involvement comes to light, I am aware that I cannot plead any excuse from any authorities and shall have to abide by the decisions of the Institution in this regard. Signature of the Parent Signature of the Student Date: In the event of a parent not knowing English, the following declaration has to be obtained from any official in the neighborhood I have explained the contents of the above declaration to Mr./Ms., parent of Mr./Ms.. Name and Designation with office seal if any. Signature of the person explaining, with date

8 Form No.1 AMRITAPURI CAMPUS SEAT ACCEPTANCE LETTER 1. I accept the seat allotted to me for admission to programme. The allotment has been done according to my option and free will with reference to the vacancy position prevailing at the time of my counselling and the allotment is final and binding. 2. I am aware that the allotment of the said seat is subject to eligibility conditions as per the admission procedures and policies laid down by the university. I have submitted the relevant documents / I will submit the relevant documents in proof of eligibility on or before the date stipulated in the Provisional Admission Order, failing which I understand that the above allotment of seat automatically stands cancelled. 3. I understand that the confirmation of my admission is subject to my remittance of all dues to the Institution and submission of necessary documents on or before the date stipulated in the Provisional Admission Order. 4. I am aware that my non-compliance of the requirement for admission shall make the Provisional Admission Order lapse and such a lapse will amount to depriving the chance of another eligible candidate getting admission to the above branch of study in the Institution. 5. I am aware that admissions to the above programme will be closed within 10 instructional days from the date of commencement of classes. I am also aware that if a student withdraws from the programme after this date, he / she will not be eligible for refund of fees, as the seat consequently falling vacant will not be filled up. 6. I hereby agree to abide by all the rules and regulations of the Institution. 7. Provisional Admission Order will be sent to the id of the candidate Signature of Parent/Guardian: Signature of Candidate: Name in Capitals: Date: Name in Capitals: Date: