ALAGAPPA UNIVERSITY, KARAIKUDI

(Re-accredited with A Grade by NAAC)

PG DIPLOMA IN MANAGEMENT & INFORMATION TECHNOLOGY PROGRAMME
APPLICATION FORM 2014 2015
1. Name of theCandidate (in Block Letters) with initials at the end (Each letter in each Box)
2. Fathers/Guardians Name
3. Name and Address for Communication(In Block Letters)
Pincode:
Email
Mobile No:
4. Date of Birth (DD/MM/YYYY) : Age :
5. Nationality : Indian other
6. Gender : Male Female Transgender
7. Community : SC SCA ST MBC/DNC BC BC(M) OC
(Attested copy of Community Certificate should be enclosed)
8. Special Category : Person With Disabilities Ex-Servicemen Any Other
9. Educational Qualification:
(Attach attested photocopy of all mark statements)
Examination
Passed
School /
College studied
Board /
University
Subject/Course Year of Passing Class Percentage of
Marks
S. S. L. C
H. S. C
UG
10. Application Cost Details(only if Download):
DD Amount : Date : Bank :
DECLARATION:
I declare that the particulars given above are true and that I shall, if admitted abide by the rules of the University.
Signature of Parent/Guardian Signature of Applicant
Place:
Date:
Note: DD should be drawn in favour of The Registrar, Alagappa University Payable at Karaikudi for Rs. 100/- (Rs.
50/- for SC/ST Students). Application Form should be sent to the Director, Computer Centre, Alagappa University,
Karaikudi-630003.
Affix recently
taken Passport
Size
Photograph
attested by the
Gazetted
Officer