University Administration Management

Application Entry

Programme Applied*

Applicant's Name*
(IN CAPITAL LETTERS)

Add initial at the end

Date of Birth*
(dd/mm/yyyy)

Father / Guardian*

Name of the Guardian

Name of the Father & Mother*

Father's & Mother's Occupation*

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Gender*

Mother Tongue*

(if others)

Nationality*

(if others)

Religion*

(if others)

Note : Applicant from Other State / Country should select OC only

Community*

Select

Address for Communication*
(Line 1)

Line 2*

Line 3

District*

Pincode*

State*

Country*

Mobile No.*

Telephone No.(LL)

E-mail ID*

Aadhaar Card No.*

Select

Special Quota

Ex-Servicemen

Select

Differently Abled

Select

Percentage of Disability

Sports Quota

Select

Others

Select

Native Place

Native Village / Town*

District*

State*

Permanent Address

Address Line 1*
(Line 1)

Same as Communication Address

Line 2*

Line 3

District*

Pincode*

State*

Country*

Educational Qualification

is Covid 19 batch in SSLC

Course	Institution	Board	Subject Studied	Register No.	Mark obtained in Percentage	Month & Year of Passing	Regular / Private Other Mode	Attachment
S.S.L.C. (X Std.)						Month of passing is Required! Year of passing is Required!		Select*
HSC(+2)						Month of passing is Required! Year of passing is Required!		Select*

SSLC (X Std.) Mark*

HSC (+2) Marks*

Subject Name	Maximum Marks	Obtained Marks

Subject Name	Maximum Marks	Obtained Marks

Do you have internet facility at your home?

Yes

DECLARATION : I declare that the information given above are true to the best of my knowledge and that I shall, if admitted abide by the rules of the University.

I agree to above declaration

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Signature of the Parent

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Signature of the Applicant

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PERIYAR UNIVERSITY

Salem-636 011, Tamil Nadu, India

NAAC with 'A++' Grade - State University - NIRF Rank 59- NIRF Innovation Band of 11-50

Application for Admission in to Integrated Programmes 2024 - 25

Special Quota

Native Place

Permanent Address

Educational Qualification