AWH SPECIAL COLLEGE i (AFFILIATED TO UNIVERSITY OF CALICUT) | _ ‘SANCTIONED BY GOVT. OF KERALA tat 21/10, KALLAI P.O., CALICUT-673003 aoa PHONE: 0495 - 2323526, 2325408, 2325250 | No Es Application for the Admission to B.Sc. Programme Under CUCBCSS 21 20... T Choice T choice Ti chowe Core Course Chosen Common course chosen language | Mal/ Find (Select an ther than English en oman ‘ieee cfm In English (in block letters) Candidate ‘In mother tongue 2 Permanent Residence Aderess AdGress to which communications are tobe sent Pin Ph Pin Ph 4. Sex Male/Female 5.Age 6. Date of ith 7. Place of Birth 8. Vilage / Town: 9 Tak 10, District 11 State 12. Nationality 13, Marta Status 14, Mother tongue 15, Name and Address of Parent/Guardian 5. Name and Address of Parent / Guardia naeiant wath the applicant ceupation Pin Ph 16. Name and Adress of Local guardian —e ‘tthe appcant Occupation Pin Ph ae 17. Name of Mother 7. Religion & Community (Speaiy whetner SC ST /OEC /O8C) 18. Annual family income Re 20, Whether physically challenged? Ifyes, specify detaits | i. Educational Qualficatons {i) Name of the examination passed l (ii) Register No. and yee {wy Optional subject studied 22. Detail of marks obtained in qualifying examinations Pat ‘Subject ‘Marks obtained | Maximum Marks | Percentage Total r 23. The Name and Address of the institution through which the candidate presented for the qualifying examination 24. Name of the institution last studied & the University! Board to which itis affliated 25. No. & Date of T.C 26. Whether a recipient of scholarship/fee concession? if yes, specify details DECLARATION \ . : : hhereby declare that | have carefully read the conditions for admission and that the information furnished are true. If admitted, | undertake to abide by the rules and regulations: of the college and to actively participate in al the curricular and co-curricular programmes, Place: Date Name & Signature of the Applicant DECLARATION | hereby declare that | have known the financial obligation of my ward and | can afford to pay al the costs and undertake to pay the tution and other fees payable on te tothe college as per the rules. | am aware thatthe fee once paid tothe college for admission will not be refunded in case helshe does no join the course, he/she discontinues the studies, he /she is expelled from the college for any reason and | ave io pay he fl fees fhe cance cscontinue te couse. lo stand hy he decaton gen toe colege by my son / daughter / wa Place: Date Name & Signature of the Parent / Guardian Aitested copies ofthe following Certificates to be attached For Ofice Use only 1. First page of SSL 2. Mark list of Qualifying Examination 3. Community Certificate in case of SC/STIOBC candidate von ‘Admitted / Not admitted Principal