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Sri Ramajayam Employee ID No.

SASTRA UNIVERSITY
(A University under section 3 of the UGC Act, 1956)
THANJAVUR – 613 401. TAMIL NADU.
APPLICATION FOR ADMISSION TO M.C.A. PROGRAMME 2017-18
(Distance Education)

1. Applicant’s Name : ............................................................................................

(as in Qualifying Examination mark sheet)
2 (a) Father’s Name : Shri .................................................................................... Applicant’s
(b) Mother’s Name : Smt .................................................................................... Photo
(c) Guardian’s Name (If Father not alive) : ............................................................................................ (Compulsory)
3 Address for communication : .............................................................................................
............................................................................................
............................................................................................
Pin : ......................... District : ................................... State : ....................................
Ph : ............................................. STD Code : ...........................................................
Parent’s Email :
Student’s Email :
4. Sex : MALE FEMALE

Date Month Year Age as on : 01.07.2016

5. Date of Birth :

6(a) Parent’s Occupation : Govt. Private Income : ....................................................... p.a.

(b). Name of the Organisation : .........................................................Designation : .......................................................
7(a). Nationality : ..................................... 7(b). Religion ..................................................................
8(a) Community : BC OBC MBC SC ST OC

8(b) Name of the Caste : ......................................................................................................................................

9. (a) Programme applying for : Master of Computer Applications

(b) Campus (Separate applications : Main Campus

if applying for both campuses)
10. Qualifying Examination Passed :
(a) Month and Year of Passing
(b) Name & Address of the
College Studied/Studying
(c) Name of the University
(d) Registration No(s). with Month
and year of Last Appearance :
Thanjavur
.................................................................................................................................
: .................................................................................................................................
: .................................................................................................................................
: .................................................................................................................................
.................................................................................................................................
: .................................................................................................................................
.................................................................................................................................

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 11. Marks / Grade obtained in qualifying Degree Programme
UG Degree obtained: ............................................................. Branch of study: ................................................................

I SEMESTER / I YEAR II SEMESTER / II YEAR

Marks / Maximum Marks / Maximum
Subject Grade Marks / Subject Grade Marks /
Scored Grade Scored Grade

1. 1.
2. 2.
3. 3.
4. 4.
5. 5.
6. 6.
7. 7.
8. 8.
9. 9.
10. 10.
Total Total

III SEMESTER / III YEAR IV SEMESTER

Marks / Maximum Marks / Maximum
Subject Grade Marks / Subject Grade Marks /
Scored Grade Scored Grade

1. 1.
2. 2.
3. 3.
4. 4.
5. 5.
6. 6.

7. 7.
8. 8.
9. 9.
10. 10.
Total Total

Please enclose DD for Rs.15,300/- (first semester registration and application fee ) favouring SASTRA University payable at Thanjavur

Name of the Bank ....................................................................... Branch: ..............................................

D.D. No ................................................................................... Date : .............................

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 V SEMESTER VI SEMESTER
Marks / Maximum Marks / Maximum
Subject Grade Marks / Subject Grade Marks /
Scored Grade Scored Grade

1. 1.
2. 2.
3. 3.
4. 4.
5. 5.
6. 6.
7. 7.

8. 8.
9. 9.
10. 10.
Total Total

Overall percentage in qualifying UG degree : ........................................

GENERAL INSTRUCTIONS
1. The name you provide will appear identically on all official documents.
2. Indicate your permanent address. Your permanent address is a stable address, which will be valid for
a long period of time. This is the address where you may be reached, even if your mailing address
changes. Indicate the phone number, residence and mobile number, fax number and the email address.
3. Indicate your qualifying examination passed, year of passing, register number, number of appearances
and the marks obtained in the qualifying examinations. Photocopies of the individual mark sheets
/ Cumulative mark sheets, Provisional Certificate / Degree Certificate, Transfer Certificate
should be enclosed.
5. Fees once paid will not be refunded under any circumstances.
6. SASTRA reserves its right not to conduct a programme, if the response to that particular programme
is not sufficient.
7. SASTRA wishes that there be no dispute on any account. However if there is any dispute the jurisdiction
will be Thanjavur, Tamil Nadu and only through appropriate Forum. No third party intervention will be
entertained under any circumstances.

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 JOINT DECLARATION BY THE APPLICANT AND PARENT / GUARDIAN

I hereby solemnly and sincerely affirm that the statement made and the information furnished by me
in the application as also in enclosures thereto submitted by me are true. Should it, however, be found that
any information furnished therein is untrue in material particulars or on verification at a later stage, I am
liable for criminal prosecution and I also agree to forego my seat in this Institution / for the removal of my
name from the rolls of the institution at whatever stage of study I may be at the time of detection of such
wrong particulars. I am also fully aware of the general instructions and I am bound by the same.

Place :
Date : Signature of the Candidate

I am fully aware of the above declaration and I have understood the same. I agree to the above conditions.

Place:
Date : Signature of the Parent / Guardian

Note: The guardian can execute the above declaration, only if both the parents are not alive.

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 SASTRA UNIVERSITY
THANJAVUR – 613 401.
STUDENT’S INDEX CARD
Master of Computer Applications (Distance Education) Degree Admission 2017 - 18
Employee Identification No. Register No. (Office use only) :
(TO BE FILLED BY THE APPLICANT IN CAPITAL LETTERS)
Name : ....................................................................... Aadhaar No. : ..........................................
Sex : ........................................... Nationality : ..........................................
Date of Birth : ...........................................
Name of the Religion : ..........................................
Father’s Name : Shri......................................
Name of the Caste : ..........................................
Mother’s Name : Smt ....................................
Guardian’s Name : ........................................... Community : BC/OBC/MBC/SC/ST/OC
Relationship with student : ........................................... State : ..........................................
Occupation of Father / Guardian : Govt. Private
Name of the Organisation : ........................................ Occupation of Mother : Govt. Private
Designation : ........................................ Name of the Organisation : ..........................................
Father/Guardian’s Annual Income : ...................................... Designation : ..........................................
Mother’s Annual Income : ..........................................
Communication Address : ....................................................................................................................................
.............................................................................................. Pin Code : ......................
Ph No : With STD Code (Off) : ......................................... (Resi) : ................................................................
Mobile : ............................................., .............................................. Parent’s E-mail :
(Parent) (Student) Student’s E-mail :
Academic Details :
Qualifying Exam Passed : ................................ University : .....................................................................
Institution Name : ................................................................................................................................................
Register No. : ......................................................... Month & Year of Passing : .....................................................

Overall Percentage : ............................................. Class obtained : ...................................................

Affix Affix Affix Affix

Student’s Father’s Mother’s Guardian’s
Photo Photo Photo Photo
(Compulsory) (Compulsory) (Optional)

Signature of the Student Signature of the Parent Signature of the Guardian

Joined TCS through iGnite: Yes / No (tick any one). If yes, iGnite Batch Number:
Signature of the Company’s Signatory with seal and date:

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