SRM Institute of Science and Technology

(Deemed to be University u/s 3 of UGC Act, 1956)

ADMISSIONS 2023-2024
PROFORMA FOR STUDENTS WHO HAVE TAKEN A BREAK IN THEIR STUDIES
(Mandatory for all students with more than one year of break in education)

Particulars Details

Name of the Applicant

Application number

Program Applied

Mobile number of the Applicant

Number of years of break in
studies

Reason for the break *

Have you discontinued from any

other institutions?

If YES, give details about the

Program last studied, Institution
and Reason for discontinuing.

Signature of the Student

Remarks of the Head of the

Department (For Office Use
Only)
Signature of the Head of the
Department

 Note: The necessary documents for proof of the reason for the break in studies should
be attached. For example, if an applicant took a break to prepare for
NEET/JEE/CLAT/CAT or Other Competitive exams and did not enroll elsewhere
during that time, they may submit their school transfer certificate and hall ticket for
those exams. The decision rendered by the Dean and the admission committee is
absolute and definitive. It signifies that the decision has been made after careful
evaluation and consideration of all relevant factors