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Pending Approval Christian Medical College, Vellore - 632002.

Online Application form - 2021
Summer Admission Courses 21060401191
1. Name of the Candidate : M.JENIFER
2. Father's Name : MAGIMAIDOSS
3. Father's Occupation : MIDDLE LEVEL MANAGEMENT / PROFESSIONAL
4. Mother's Name : M.KALAISELVI
5. Mother's Occupation : HOUSE WIFE
Address for communication
6. House No./Street Name : RAILWAY ROAD VEPPAMBATTU
7. Post office/ Taluk name : CHOLAVARAM POST
8. City Name : VELLORE
9. State name : TAMIL NADU
Only Candidate's Signature Acceptable
10. Pin Code : 632113
11. Mobile No. : 8111025353,9751848208
12. E Mail Address : gladwin19042001@gmail.com
13. Date of Birth : 21/09/2002
14. Gender : Female
I declare that all information in this form is correct. I understand that
15. Religion : Christian falsification of data will result in automatic disqualification. I
hereby declare that I have read the rules & regulations regarding ragging
16. Community : Scheduled Caste as given in the Prospectus 2021-2022 and agree to abide by the same.
17. Nationality : Indian Declaration by candidate
I M.JENIFER child / ward of MAGIMAIDOSS hereby consent
18. State of Domicile : Tamil Nadu to the collection, storage and processing of data submitted
herewith, by Christian Medical College Vellore and
19. Marital status : Single its authorised agencies for admission, educational and
related quality purposes.
20. Mother Tongue : Tamil
21. Qualifying Examination Completed : Plus Two (+2) T Nadu Board
22. Course(s) applied for in order of your preference
: - Basic Administrative Fee Rs. 800
Undergraduate Degree Courses (Group A)
Pref Course Code - Course Name Category Code Applying under Minority Network Category (Y/N) Reg Fee
First 002-BSC NURSING - VELLORE CAMPUS SC/ST No Rs. 500
Second 004-BPT Minority Network (Y) 25-C.S.I. VELLORE DIOCESE Rs. 500
Third
Fourth
Fifth
Sixth
Seventh
Eighth

23. Has your brother / sister also applied for above course(s) this year : No
24. City for Entrance Test : First Choice - Vellore Second Choice - Chennai

Payment Mode : PAYU Total Application Fee : Rs.1800 (Includes Basic Administrative Fee Rs.800)
PAYU Ref. No: 20210606O0679923 Bank Transid: IGALGMDVI2 Authentication Id: IGALGMDVI2 Status: Yes Online Amount: Rs..1800
List of supporting / relevant documents to be sent to The Registrar, CMC, Bagayam, Vellore – 2 before the last date
*Send the clear photo copy of SC/ST certificate. If the Certificate is in vernacular language, attested English translation should be attached.