mmo mmom VAGA CAMPUS

goo omu TRCHY ROAD

gy om_) -613 010 THANJAVUR-613 010
1. mmmmmgm)) Om) :
Name of the Applicant :
(in block letters)
(gm g gm , _m o ug g gm ) (gm g gm , _m o ug g gm ) (gm g gm , _m o ug g gm ) (gm g gm , _m o ug g gm ) (gm g gm , _m o ug g gm )
2. g_g/gm/omm)/ommmm)Om) :
Name of Father/Mother/Husband/Guardian :
( gm g gm , _m o ug g gm ) ( gm g gm , _m o ug g gm ) ( gm g gm , _m o ug g gm ) ( gm g gm , _m o ug g gm ) ( gm g gm , _m o ug g gm )
3. Ogmc)q _om), o1mo mm. :
Address for Communication
with Pincode & Mobile Number
4. mm mm mg g mc cm /mmcm /m) :
(_moumu/_gou/_g__mu/
_mu__y)/ _mm) mccm)
(B.Ed/M.A.,/ MSc.,/M.Phil/ Ph.D)
5. __gg 1g) _og_g gmo / :
_m_ / mmOmmgg 1g) _m
Month and year of last appearance/
Date of Viva
6.gc _Ommg gmgm Omm mc qu m_ _m :
g_omuoo omm_
(_ou _moommc 1mm_m )
Copy of Consolidated Marksheet and
Provisional Certificate enclosed
7. mccmmqo omm_gg Om_mg_)
occmm Ooggg mm)m :
Particulars of fees paid for the
award of degree
0emand 0ratt No. date Name ot the 8ank 1am|| Un|verc|ty ||nance Amount
cect|on 8ece|pt No. 8 0ate 8c.
8._ 1mc qm gum q :
Title of the Thesis
( only for M.Phil & Ph.D)
(gmggm, _mougggm)
_m : mmmmmgm)) oOmmmm
Date: Signature of the Candidate
Ogmu_ um mqm q (Distance Education) Ogmu_ um mqm q (Distance Education) Ogmu_ um mqm q (Distance Education) Ogmu_ um mqm q (Distance Education) Ogmu_ um mqm q (Distance Education)
z01zgm gmaaam attarag@ |mmaam
App||cat|on tor Adm|cc|on to the Convocat|on-z01z