FACULTY OF SCIENCE AND HUMANITIES €SRM UNIVERSITY Application Number lho be lleted by the univers) 1. PHOTOGRAPH + Fill deel in English using CAPTAL Levers + Read carefully the instructions to fill details Reece + Use black or ble Hi-Tech point pen for filing details Boro! pn or sop + Mai he filed application to Director (Admissions, SRM Univesity, SM Nagar, Katonkulabur 603 203, Kancheepuram Ds, Tamlnady, lnk 2, NAME OF THE APPLICANT 3. DATE OF BIRTH 4. GENDER DAE MONTH Yen MAE FEWALE 5. RELIGION 6, NATIONALITY Ss i vA fe) ey g 5 fay 4 7. NAME OF THE PARENT / GUARDIAN 8. COMMUNITY 9. MOTHER TONGUE General / OC o8c 8c mac sc st 10. ADDRESS FOR CORRESPONDENCE (DO NOT REPEAT NAME} SRM UNIVERSITY nny 12. STATE 13, PIN CODE 14, SID CODE 18. TELEPHONE NUMBER 16, MOBILE NUMBER. 17. E-MAIL ADDRESSSs i vA fe) ey g 5 fay 4 SRM UNIVERSITY 18. PARENTS INCOME (@) Below 50,000 50,00} to 1,00,000 1,00,001 te 2,00,000 | 200,001 te 4,00,000 ‘Above 4,00,000 19. PARENTS OCCUPATION 20. MEDIUM OF INSTRUCTION 21. DETAILS - X* AND XI STANDARDS REGISTRATION MONTH? SCHOOL BAM, SCHOOL BOARD (CODE) eee vent hive OF MARKS xi) x 22. DETAILS OF QUALIFYING EXAMINATION FOR PG / PG DIPLOMA PROGRAMS REGISTRATION MONTH? EXAMINATION. coUeGe UNweRsity Sener enh tsi | AGGREGATE %6 MARKS 23. HOSTEL REQUIRED 24. SPORTS ACHIEVEMENT(S) YES NO. STATE NATIONAL [INTERNATIONAL NONE 25. PROGRAM APPLIED BA. | BBA | BCA|8Com| BSc. | BEd | BS Diploma] MA [MCA] MSc | MEd | MPhi | PGDiplome 26. BRANCH / SPECIALIZATION 27. PAYMENT OF APPLICATION FEE OF % 750/- TO BE DRAWN IN FAVOUR OF 'SRMIST, PAYABLE AT CHENNAI PAYMENT MODE | NUMBER | AMOUNT ®) DATE ISSUING BANK NAME BRANCH BANK CHALLAN, DEMAND DRAFT 28. DECLARATION hereby declore that have carefully read the instructions end particulars supplied to me and thatthe entries made inthis application form ta the best of my knowiedge and belief. | note that the decision of the University is final in regard to selection for admission. I selected for admission, | promise fo abide by the rules and regulations of the Universiy and the guidelines in the prospectus, The Universiy shall have the right to expel me from the University at any ime after admission, provided its satisfied hat | was admited on {alee particulars furnished by me.or my ontecedenis prove that my continuance in he Universiy is not desirable, lagres hot all disputes ore subject fo the jurisdiction of the courts at Chennai only, Fees paid on counseling and admission will nat be claimed back under any cireumstan: SIGNATURE OF PARENT / GUARDIAN. SIGNATURE OF APPLICANT DATEINSTRUCTIONS FOR FILLING APPLICATION 1, PHOTOGRAPH: Paste your most recent colour photogreph in the given space. Do not staple or pin the photograph. The Applicant to ‘sign within the box below the photograph 2, NAME OF THE APPLICANT: Write your name in CAPITAL LETTERS as t appears in your Xth standard mark sheet. Leave one blank box between odjacen’ words. Do not use ony prefixes like Dr, Mr, Mrs., Miss, Ms, ele. For example, MIR. RAVI SUNDAR SINGH should be writen os: rfalvli sfulNiolale s|i|Nio|# 3. DATE OF BIRTH: Enter the date, morth and year of your birth as recorded in 10th standard mark sheet in DD/MMY/YY format only. For single digit numbers, zero should be prefixed. For exemple, 27th Januory 1993 should be writen as 2/7 of rigle)s 4, GENDER: Tick the appropriate box. v MALE FEMALE 'S.RELIGION: Fill up your religion. For example, if your religion is Hindu, it should be written as WH] 1)N} oly 6. NATIONALITY: White your nationality. For exerale, f you are an Indian, it should be writen as: fnfofryayn 7. NAME OF PARENT/GUARDIAN: Write the name of your parent or guardian. For exemple, MR. SUDIR KUMAR SINGH should be writen as: sfulo]i}e| |klulmfale s|i|nNio|H 8. SOCIAL STATUS / COMMUNITY: Fill your Social Status / Community. For example ifyou belong to OTHER CASTE, tick as below: cenerat/oc) | ¥ | |o8c 8c ac se st 9. MOTHER TONGUE: Rela othe fable below for codes. For example il your mother longue is Hindi, wite as below i fa Dike iio ik ii «iy Assamese n Oriyo w Bengali 2 Punjabi 20 Gujarat 13 Rojasthoni 21 Hindi u Sindhi 2 Konnada 15 Tomi 23 Koshmir 16 Telugu 24 Moloyalam ” Urdu 25 Moxoti 18 Others 2%10. ADDRESS FOR CORRESPONDENCE: Write the complete postal address including PIN CODE to which communications are fo be sent. Also write the telephone number with STD code and e-mail address if any. For exomple, the address, (MR. RAVI SUNDAR SINGH, S/O SUDIR KUMAR SINGH, NEW No 20, OLD No 23, 2ND CROSS, INDIRA NAGAR, ADAYAR, CHENNAI 690020 [ADDRESS FOR CORRESPONDENCE (00 NOT REPEAT NAME), Nlelw| |nlo 2}o} ;olt)o] |njo} fais 2)njo} |clrio/s|s ifnjolrfr}al |njalelale},}alolalyjale 11.CITY: Fil in your cis name. For example, the city ‘Chennai should be writen os clalelnfnfale 12.STATE: Refer to the table given below for state codes. For example, the state Toril Nadu’ should be written as alls eS eds en 1 Miron 3 Arch Pads 2 Nosaond » = 3 One a ter v4 Pin 2 etiooh 3 Task 3 Osh ve Sin % Ges 7 Tomo 3% Gujarat 18 Tripura 36 For n Utero a Vinal 2 race 3% Ton on a 21 Was Bere » etn 2 Peron ar ® — Fa Credo Ui a tl 7% Deda od Neg He 2 Madiys Podah 25 Donen rd Bw UT 2 chose 26 kde “ ‘Manipur a7 Puducherry (UT) 45 os Ee 13.PINCODE: Fill up with the appropriate 6-digit Pin code. For example, the Pin code 600 020 should be written os: 6fol}olo/2}o 14. STD CODE: Fill up the STD code in the boxes provided. Use zero when prefixed to the STD code. For example, the STD code for ‘Chennai '044' should be writen as15, TELEPHONE NUMBER: Fil up your phone number inthe boxes provided. For example, tne telephone number 42022527 should be weiten os: al2jol2}2|slai7 16, MOBILE NUMBER: Fill up your mobile number inthe boxes provided ond do not arefix'0 or eave any blank spaces between numbers. For example, the mobile number 99400 36049’ should be writen os: glelalolo|s/slolalo 17. EMAILADDRESS: Fill up she email id in CAPITAL lars without blank spaces. For example, the e-mail id ‘avisundarsingh@gmail.com’ should be written os rjalvi[i)s|ulnjofalels/i|n{o}Hfe@le|m/ali}e}-fclolm 18. PARENTS INCOME @): For example, ifthe parents income is 2,00,009, tick os: Below 50,000 50,00} to 1,00,000 1,00,001 te 2,00,000 | _ 2,00,001 te 4,00,000 Above 4,00,000 v 19. PARENT / GUARDIAN OCCUPATION: Wei it should be written os: the occupation of your porent. For example, if your parent is in Busi slo [isccrrnon i ccoe i occrmon oor ‘GOVERNMENT SERVICES PROFESSION IAS nl Engineer 41 LPs 12 Doctor 2 LFS 13 Chartered Accountant “a SERVICE CATEGORY Lawyer 44 Amy 21 Aarictralit “5 AirForce 2 ‘ist 46 Nowy. 23 Software 47 Police 24 Consultant 4 “diary 25 Teacher 49 ther Govt Senices 2% Self Employed 50 PUBLIC SERVICE ther Private Sector 5) Minister Centol Govt 31 Business 60 Minister, State Gow, 32 Others 70 MP 3 MIA 34 MC 35 Member of Locel Body 36 20. MEDIUM OF INSTRUCTION: If your medium of instruction is English, it should be written os: e}n|eo}esruls]#21. DETAILS X AND Xil STANDARD: Wiite the School / College, Board / University code, Registration No., Month and Yeor of Passing ond ‘aggregate percentage marks obtoined in Xin standard / eggregote percentage morks obtained in PCM [Physics-Chemistry-Maths) / PCB {Physics-Chemisty- Biology} in XI sid or equivalent examination. In case the Xl result has not been published, che marks obtain should be sent on-line and mark shaet should be produced at the time of counseling. (Refer the table below, an excmple for Board / University code) For exomple, i you ore from Church Pork School, Tamil Nadu Boord of Higher Secondary Educolion, possing Xl standard in Moy 2017 wih X standard score of 95% i should be water os: sen001 Ba SeH00 0 00 asraronna | MONTYEROF ‘sank Nome of Boord Code “Andhra Pradesh Board of Inermediate Fdvcation 11 ‘Assam Higher Secondary Edveation Council 2 Bihar Itermediate Education Council 1% Ceniral Board of Secondary Edvcation 4 Chatsgarh Madhyarik Shiksha Mandal is Council forthe indian School Cerificate Examinations n ‘Goo Boord of Secondary ond Higher Secondary Education 7 Gjor! Secondary and Higher Secondary Education 18 Haryana Board of Education 9 Himachal Pradesh Board of School Education 20 TAK SioteBoord of School Edveaion 21 Tharkhond Academy Counel 2 Kamctaka Board of Pr-unwary Education B Kerala Board of Public Eraminaions 24 “Medhya Prodesh Board of Secondary Education 25 Meherashre Stie Bord of Secondary and Higher Secondary Education 26 Maripur Counal of Higher Secondary Education 2 Megholaya Boord of Secondary Education 28 Mizoram Board of School Education 2 Nagaland Board of School Education 30 issa Council of Higher Secondary Edveation a) Punjab School Education Board 3 Rojosthon Board of Secondary Education 3 Tori Nadu Boord of Higher Secondary Education 3 Tipora Board of Secondary Education 35 UR Board of Figh School & Intermediate Education 36 Uforanchal Shiksha Ever Porksha Pashad 7 West Bengal Counel of Higher Secondary Edvcaion 38 Others 39 22. DETAILS OF QUALIFYING EXAMINATION FOR PG / PG DIPLOMA PROGRAMS: Write the name of the auolif College, University, Registration No., Month and Year of passing and percentage marks obtained. Incase the result has not been 19 examination, published, the marks obtained should be praduced athe ime of counsaling. For example, an MSc., applicant should give B.Sc, details. PIAMINATION 1 Niversry no, | MONTHIYERROF Tes cate x MARK “ PASSING SEREGATE MM Be sai Ars &Soenee Cale SR Univer earn wway 201123. HOSTEL REQUIREMENT: Tick YES' if you require an on-campus Hostel Accommedetion, Forea, YES NO. v 24. SPORTS ACHIEVEMENTIS): Wite your sporsachioveren' love. Fr example, fyou had played atthe ‘Natonel Level’ tick he box as below: STATE NATIONAL — | INTERNATIONAL NONE v 25.PROGRAM APPLIED: Tick your proferred branch. For example, if an applicant is applying for B.Sc, tick the box as below: BA [884 | BCA[8Com| BSc | ats | BS |Diplomo] MA |MCA| MSc | Méd | MPhil | PGDiplome v 26. BRANCH/SPECIALIZTION: For the Branch code, refer to the lst given in pages 6 and 7. For exemple, if an applicant is applying for B Se wth Branch / Specialization ‘Biotechnology’, it should be writen as of afar 27. PAYMENT OF APPLICATION FEE: For application fee of € 750/- ‘9. BANK CHALLAN: Fill up the Number, Amount, Date, Issuing Bank & Branch name, Also, wile your name on the reverse of the Challan, b. DEMAND DRAFT: Fillup the DD number, Amount, Date, Isuing Bank & Branch name. Also, wrte your name on the of the DD. 28. DECLARATION: Applicants and the Parent / Guardian must sign {with dete) the declaration to authenticate the information provided by them. Unsigned applications will not be accepted, LAST DATE OF ACCEPTANCE: 15TH MAY, 2011 [MAIL THE FILLED APPLICATION ALONG WITH A DD FOR 750/- TO THE DIRECTOR (ADMISSIONS) ‘SRM UNIVERSITY SRM NAGAR, KATTANKULATHUR 603 203, KANCHEEPURAM DT, TAMIL NADU, INDIA, E-MAIL: diradmissions@srmuniv.ac.in TEL: +91-44-2745 5715 / 3433 / 3788 491-44-2745 2270 extn. 1451 FAX: +91-44-2745 3622{Reference for Item No. 26) BRANCH/SPECIALIZATION CODE FACULTY OF SCIENCE AND HUMANITIES BA Econometics of of] 4 Journalism & Mass Communication o|o| 2 BBA Bachelor of Business Adminstration o| ol] 3 aca Bachelor of Computer Application o] ol] a 8.Com. | Corporate Secretanship ol ols Bank Monagement ol ol] 6 Morksting Monagement o| ol? Accounting & Finance o|o|s BSc Applied Mathematics, o|o| 9 Bioinformatics o]1]o Borechrology ofa f4 Borechnology & Bioinformatics of 1] 2 Compuar Science ond Technology o} ifs Computer Science of ia Fim Tecmlogy o} i]s Hotel & Cotering Menagement o} 1] .6 Information Technology of i] 7 Informolion & Sytem Management o} i]s Visyal Communication of i] 9 ae Bachelor of Education o | 2] 0 as Biotechnology of 2] 4 Computer Science o | 2] > Information Technology o|2]s3 DIPLOMA COURSES DHMCT | Diploma in Hotel Menagement & Coterng Technology o | 2| 4 Dd | Diploma in Teacher Education o | 2/5 DFA Diplome in Fim Acting o| 2] 6BRANCH/SPECIALIZATION CODE FACULTY OF SCIENCE AND HUMANITIES MASTERS DEGREES vio fa MA Economelice vito]. Jouralm & Mots Communication vito s Intemational Relations rfo la Pub Administration vfols MCA | Mosterof Computer Application rfo |e MS vito lz rif ols Computer Science end Tech rfols Information Technology 1 fa] o Hotel & Catering Monagement viata ‘Applied Mathematics, vfa]2 Vial Communication rfals ecnlogy & Boinformics vfoa la Biotechnology & Bioinformatics (tegrated rfais Computer Science & Tech. (negroes) rf 1/6 MEd Moster of Education vfoa |? 2G DIPLOMA COURSES Journalism rf ais Digital Lbrory Management rfa| Mohit | Computational Mothematis 2;o|4 Education 2|o| 2