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

Stream Type*

is Covid 19 batch in SSLC

Course	Month & Year of Passing	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*
Diploma	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

Semester 1*

Subject / Course Name	Maximum Marks	Obtained Marks	Month & Year of Passing
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!

Semester 2*

Subject / Course Name	Maximum Marks	Obtained Marks	Month & Year of Passing
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!

Semester 3*

Subject / Course Name	Maximum Marks	Obtained Marks	Month & Year of Passing
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!

Semester 4*

Subject / Course Name	Maximum Marks	Obtained Marks	Month & Year of Passing
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!

Semester 5*

Subject / Course Name	Maximum Marks	Obtained Marks	Month & Year of Passing
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!

Semester 6*

Subject / Course Name	Maximum Marks	Obtained Marks	Month & Year of Passing
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!
			Month of passing is Required! Year of passing is Required!

Name of the College Last Studied*

Name of the University Last Studied*

Qualifying Degree*

Month & Year of passing*

Awaiting for Final Semester Marksheet

Total Maximum Marks	Total Marks Obtained	Percentage of Marks	Class Obtained	CGPA	Overall Grade	Mark Sheet Attachment
						Select*

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 Diploma Programmes 2024 - 25

Special Quota

Native Place

Permanent Address

Educational Qualification

Semester 1*

Semester 2*

Semester 3*

Semester 4*

Semester 5*

Semester 6*