ST DOMINIC'S COLLEGE KANJIRAPPALLY

APPLICATiON FOR ADMISSION To UG PROGRAMMES (2022-2023)

MANAGEMENT QUOTA

1. 8P rleih0}0 n0003u9omUl mdouaanaveioos coiølard

GruDdgeiod mldaumuavao oslgd 9.a/Q8mbd eslanm oslgyd mmd

0 0 I D cn0oalod luolo moomoi
cono1soolwlolanemo.
2. 0gP cagmg)ydgmaalyolaeuoo Ga0Do

2 2d elgyyau GniDsmm eodaom odnnmoyanea lad wo

9mglolaym mdslholaop,_gmlauwyos l GonDalamao
madoGeOnEDDeM.
3. +1, +2 enei_60aglo mudslnslengzad ao(0ca canbamas 2desl

1. MGU CAP Registration No

2. Full Name (ln Block letters)

3. Date of Birth 4. Gender: 5. Religion& Caste:

6. Address for communication with Pincode:

7. Mobile: 8. Email ID

9. CHOICE OF THEDEGREE PROGRAMME PREFERENCE 1.

PREFERENCE 2.

PREFERENCE 3.

10. Second language preferred (Please tick): MALAYALAM HINDI

 CANDIDATE'S MARK DETAILS

Subject Marks Secured Maximum Marks

GRAND TOTAL

11. Whether Eligible for NSS/NCC/SCOUT/ Ex-military Bonus mark, (if Yes, specify):

12. Percentage of Marks Secured : 13. Board ofExamination

14. Name and Contact number ofthe Parent

DECLARATION:

I hereby declare that all the informations provided by me are true and complete to the best of my
knowledge.

Place:

Date: Signature of the Student

 PARISH LEVEL DETAILS (to be filled by Vicar)

Name of Parish & Diocese

Put mark against appropriate answers given in the following table

1 Class completed in Sunday School X XI XI

2 He/She is a member of Sunday SchoolStaff/ SMYM

Alter Boy / Other Spiritual Organisations

Does anyone from his/her family teach in Yes No

Sunday School
Does he /she actively involve in any of the Very active / Active /Inactive
parish organsations, programs etc

5 Character and Conduct Very Good/ Good/Satisfactory/NotSatisfactory

Does he /she activelytake part in the Holy Very Often /Often / Rarely/ Never
mass
Does he /she show interest in receiving Very Often /Often / Rarely / Never
sacraments

8 Has he/she attendedtheannual retreat Yes No

9 FinancialCondition Very Good/ Average/ Poor/Very Poor
10 Contributions / Services rendered by
students parents orsiblingin the parish
11 A Any other matter that demands special
consideration
 RECOMMENDATION LETTER FROM VICAR
This is to certify that . ************* *********
.Daughter / Son of
*** ***********

******************************* ****** ******a******************* belongs to ** ****** ********** *** *sd *** *e *** ********* *********** ****** ********* ********

under the Diocese o f .**************

. ** a n d is known to me for.***********e..years/ months

and his/ her character and conduct is . .hereby recommend him / her

for the admission to Degree course at St Dominics College, Kanjirappally under Management Quota.

Place
SEAL Name &Signature of Vicar
Date: