University Admission Form

PRAYAGA

Confluence that influence your destiny!

FOUNDATION FOR EXCELLENCE AND TRAINING

Kunnathurmedu, Palakkad

prayagainstitution@gmail.com

Application No: Admission No:

CAP ID No:

Photo

1. Name (as in SSLC Book): 2. Expansion of Initial: 3. Date of Birth (as in SSLC Book):

4. Sex: 5. Nationality: 6. Mother Tongue:

7. Religion and Caste: 8. Community: 9. Address:

Land/Phone No: Parent's Phone No:

10. Name of Parent / Guardian: 11. Relationship: 12. Occupation of Parent or Guardian and Annual Income: 13. Whether a resident of Kerala? 13a. Name of Taluk and District: 14. Name of Institution last studied: 14a. Qualifying Examination Passed:

Reg No: Month: Year:

15. SSLC Examination Passed:

Reg No: Month: Year:

16. Number of chances taken: 17. Have you applied for management quota? 18. Are you eligible for NSS/NCC quota?

NSS: NCC:

19. Have you represented in the National / State / University level?

National: State: University:

20. Claims (if any): 21. Claims (for ex-serviceman / dependents): 22. For candidates sponsored by institutions: 23. Place of birth: 24. Course for which admission is sought:

First Preference: Second Preference: Third Preference:

25. Second Language:

26. Details of marks>

Subject	Marks Obtained	Maximum Marks	Grade	Index
Part I English
Part II Language
Part III Div:
1)
2)
3)
4)
Total of part III
Grand Total (Part I + Part II + Part III)

DECLARATION

I declare that the particulars given above are correct to the best of my knowledge and belief. I shall obey the rules and regulations of the college and undertake to attend classes and tests.

Place: Date: Signature of Applicant:

I hereby guarantee the good conduct of my ward and payment of fees. I agree to withdraw him/her in case of misconduct or failure in studies.

Guardian's Name: Phone No: Mob No: