Online Application SSA College

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APPLICATION FORM FOR ADMISSION

Programme Applying For

Programme

Degree

Please Select Degree

Personal Information

Name in full(In block letters)

Please Select Name

Expansion of Initials

Please Enter Expansion of Initials

Gender

Please Enter Expansion of Initials

Mobile Number

Please Enter Mobile No

Residential Address

Please provide a valid Residential Address.

City

Please provide a valid City.

State

Please provide a valid State.

Country

Please provide a valid Country.

Pincode

Please provide a valid Residential Address.

Please Enter Email Id

Date Of Birth

Please select Date of Birth

Mother Tongue

Please select a mother tongue.

Blood Group

Please select a religion.

Religion

Please select a religion.

Other Religion

Please Enter other information

Nationality

Please Select Nationality.

Community

Please Select Commuity

Caste

Please enter Caste

Educational Information

Name of the School last studied

Please provide a name of the school last studied.

Medium of instruction

Please enter medium of instruction

Part I Language

Please select language

Board

Please select board of examination

Exam register number

Please enter register number

Year of course completed

Please provide a Year of passing the examination.

SUBJECT		MAX. MARKS	MARKS OBTAINED	MONTH & YEAR OF PASSING
Part I Language
Part II Language
MAIN SUBJECTS

Secondary & Higher Secondary School Details

6'th Std School

7'th Std School

8'th Std School

9'th Std School

10'th Std School

11'th Std School

12'th Std School

Parents Information

Father's / Guardian's details

Father's Name

Please provide a Father's name.

Official address

Please provide a valid official address

Father's occupation

Please enter father's occupation

Father's annual income

Please father's annual income

Mobile number

Please enter mobile no

Mother's details

Mother's name

Please provide a mother's name.

Official address

Please provide a valid official address

Mother's occupation

Note:(If hasn't Occupation, Please enter NA.)

Please enter mother's occupation

Mother's annual income

Please enter mother's annual income

Mobile number

Please enter mobile no

Other Informations

Sports / Games Activies

Personal Identification Mark - 1

Personal Identification Mark - 2

Aadhar Number

Please enter Aadhar Number

Student Bank Account details ( Individual Account )

Student Name

Bank Name

Branch Name

Account No

IFSC No

Examination Register Number

10th Std

Please enter 10th Std

12th Std

Please enter 12th Std

If differently abled, specify?

Yes

Whether Parent is Ex-Service Man ?

Yes

Whether First Generation Learner ?

Yes

Whether any Other Courses applied for in this college ?

Yes

Photocopies of the following should be brought along with the filled in Application form during the time of Admission.

STD X – Statement of Marks (Original)
STD XI – Statement of Marks (Original)
STD XII – Statement of Marks (Original)
Transfer Certificate and Conduct Certificate (Original)
Certificate of Proof for Differently Abled, Ex-Servicemen
Online Community Certificate (Photocopy)
Online Income Certificate (Photocopy)
Aadhar Card Copy (Photocopy)
Blood Group Report (Original)
Other Certificates (achievements in sports and other co-curricular/extra-curricular activities) (Photocopy)
Bank Passbook First Page (Photocopy)
Passport size photos – 3 Nos

In Case of PG Admission

UG Degree Certificate
UG Mark Statement
Provisional Certificate

Declaration

I declare that my admission is at my own risk and is provisional. It is subject to the approval of the University of Madras. If, for any reason, I am found ineligible, I will not hold the College responsible. I also declare that the particulars given above are correct.