Form ‘A’

ANNAMALAI UNIVERSITY
(Accredited With “A+” Grade By NAAC)
National Service Scheme
NOT ME BUT YOU
Enrolment Form of Volunteer 20 - 20

1. Name in (Block Letters) :

2. Gender :
3. Date of Birth :
4. Class in which studying :
5. NSS Unit No. :
6. Community : OC/BC/MBC/SC/ST
7. Mobile No. :
8. Email ID :
9. Aadhar No. :
10. Height ______________(Cms) : Weight _____________(Kgs)
11. Father / Guardians’ Name :
Phone No. & Mobile No.
12. Address for Communication :

13. Permanent Address with Pin Code :

14. Blood Group (Please Tick) : O+ve B+ve A1+ A+ A1 B+ O- B- A- AB- A2B+
15. Whether you are a member of :
NSS/NCC/SSL/Scout Previously
16. Interest in any field of Sports / :
Cultural Activities
17. Mention if you already selected :
for any international / Nation
State / District Level Participation
in Sports / Cultural Activities /
Other Talents
Declaration of the Student
I hereby agree to obey all the rules and regulations of National Service Scheme and work
imbibing the sports of the scheme.

Date:
Place: Signature of the Student

RECOMMENDATION OF THE PROGRAMME OFFICER (for Office Use Only)

Admitted / Not admitted as NSS volunteer during the academic year 20 – 20

Signature of the Programme Officer Seal Counter signed by

Date: Signature of the Programme Co-Ordinator