Está en la página 1de 8


Melathediyoor, Palayamkottai Taluk, Tirunelveli 627 152. Tamilnadu APPLICATION FORM FOR B.E /B.Tech /M .E/ M.Tech /M.Sc/ MCA/MBA /Diploma /B..Ed Programms (ACADEMIC YEAR 20 -20 ) Allotment : Government Management NRI

Application Form no: Name (in block letters ) Gender : : _______________________________________________ Male Female

Address for Communication : : : : Phone No Mobile No E-Maill Id : : :

_________________________________________ _________________________________________ _________________________________________ _________________________________________ STD Code ___________ No.________________ _________________________________________ _________________________________________

PLEASE TICK ACCORDINGLY Courses Offered (for B.E/B.Tech/ M.Sc, MBA/MCA/M.E./M.Tech candidates) B.E.Marine Engineering (approved by DGS) B.E.Computer Science B.E. Mechanical Engineering B.E.Civil Engineering B.Tech. Information Technology M.E.Computer Science Master of Business Administration M.Sc. Software Engineering GME Graduate in Marine Engineering COLLEGE B.E.Aeronautical Engineering B.E.Electrical and Electronics Engineering B.E. Electronics and Communication Engineering M.E. Applied Electronics M.Tech.Information Technology Master of Computer Applications M.Sc. Computer Technology M.E.Embedded System B.Sc. Nautical Science


COURSES OFFERED (for Diploma candidates) Diploma in Computer Technology Diploma in Automobile Engineering Diploma in Electrical Engineering* Diploma in Electronics and Communication Engineering COLLEGE PSN Polytechnic College, Tirunelveli Diploma in Civil Engineering Diploma in Mechanical Engineering

PSN Institute of Technology, Nagercoil B.Ed.Mathematics B.Ed. History B.Ed. Zoology

COURSES OFFERED (for B.Ed candidates) B.Ed. Tamil B.Ed. English B.Ed.Physics B.Ed. Chemistry B.Ed.Commerce B.Ed.Botany COLLEGE PSN COLLEGE OF EDUCATION, Tirunelveli 1. a) Name of the Parent Mr.Mrs. b) Occupation of Parent : Service/Business c) Location of Office/Business where working d) Designation of Parent e) Monthly Total Income/Salary 2. Name of the Guardian (if parents are not alive) Relationship with Guardian 3. Permanent Address of Parent/Guardian PIN 4. Nationality 5. Category i) Name of the Cast ii) Sl.No. of the Certificate iii) Date of the Certificate iv) Office of issue of the Certificate v) Designation of Officer issuing the Certificate 6. Date of Birth (in wards) : : : : : : : : : : : : : : : : : : :

____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ SC/ST/MBC/OBC/BC/OC ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________

: 7. Age as on : __________Year : ________Month :_______ 8. Eye Signt (if Marine Engg.Only) : left-------------------Right------------------9 . Details of Qualifying Examinations (for B.E/ B.Tech/M.Sc/Diploma):

(in figures)

a) S.S.L.C. Subjects Maths (1) Science (2) b) H.Sc.(Academic/Equivalent) Subjects Month & Year Physics (P) Chemistry (C) Mathematics (M) English (for Marine Engg.only) CONDITIONS (if Marine Engineering) AGE LIMIT : 20 Years for 1st year admission & 22 years for lateral entry admission. PCM average should be not less than 60% Candidates should have obtained 50% marks in English at 10th or 12th standard or in the Degree/Diploma course conducted by the Board or any other University. c) H.S.C.(Vocational) Subjects Month Maximum Marks Percentage %of Related Marks out &Year Total Marks Obtained Subject (s) of 200 and {%of Vocational Related Subject(s) Subjects(s) +% of Vocational Subject(s)
Related Subject I Related Subject II Related Subject III Related Subjects Vocational Subject

Month& Year

Maxium Marks

Marks obtained


Percentage Of (1+2)

Maximum Marks

Marks Obtained


Percentage of PCMput together

Theory Practical I Practical II Vocational Subjects

d) Diploma Examinations: Subjects Pre-final Semester Final Semester 12.(ii) Details of Qualifying Examination (for M.E./M.Tec/MBA/MCA/B.Ed): Degree : B.E./B.Tech/B.B.A/B.Sc/B.Com./B.Lit/ Degree & Subjects Month & Year Maximum Total Total Marks (Branch) Marks Obtained Months & Year Maximum Total Marks Total Marks Obtained Percentage


13. Declaration by the Applicant: I, _________________________________________hereby declare that all the particulars stated in this application and enclosures, if any, are true to the best of my knowledge and belief. I shall abide by the terms and conditions of the college. In the event of suppression or distortion of any fact like category, educational qualifications, nationality etc.made in my application, I understand that I will be denied admission and if already admitted, my admission/degree acquired is liable for cancellation. I also understand that the decision of the Admission Board regarding my admission is final and I shall abide by the decision. Further, if admitted, I promise to abide by the rules and norms of discipline of the Insitute. Place: Date : 14. Declaration of Parent/Guardian: I-------------------------------------------------hereby certify that the particulars stated in this applicatioj by my son/daughter/ward, Mr./Ms. ------------------------------------------(Name of the applicant) are true to the best of my knowledge and belief and in the event of any false information, the final decision of the authorities concerned shall be binding on my son/daughter/ward. Place : Date : 15. Joint Declaration by the Parent or Guardian and the candidate I hereby, solemnly and sincerely affirm (Signature of Parent/Guardian) Name:


That the statements made and information in my sons /daughters /wards application as also in all the enclosures thereto submitted by him/her are true, should it however be found that any information furnished therein untrue in material particulars. I realize that I am liable to criminal prosecution and I also agree to the forfeit of his/her in the Institution.


3. a) b)


5. 6. 7.

8. 9.

That my son/daughter/ward would conform strictly to all rules and regulations in force now or which may be introduced in the Institution hereafter and that I realize that breach of discipline and rules on my sons/daughters/wards part would entail forfeiture summarily of his/her seat in the Institution. That I am aware of that if my son/daughter/ward does not put 75% attendance during the year/semester in theory, drawing & practical classes separately, my son/daughter/ward will not be sent for the University Examination. That I am aware of the rules regarding the condonation of attendance namely that a student failing to secure 75% attendance can get the shortage of attendance condoned by filing an application for condonation to the University along with the requisite condonation fee and supported by medical certificate, sports certificate. And that the student securing attendance below 75% in a semester will have to repeat the course work of that semester in the next academic year resulting in the loss of one academic year resulting in the loss of one academic year for the student and that students can avail the facility of condonation of shortage of attendance only once during the entire course of study. That I am aware that the curriculum of the various courses is not rigid and that my son/daughter/ward will follow the syllabi for the various courses in force at the time of his/her admission and that any revision of modification made in the syllabi during the course of his/her study in the Institution will be binding on him/her. That I am aware that if my son/daughter/ward does not get minimum of 50 percent of marks in the day to day valuation of his/her work and progress he/she will not be sent for the University Examination. That in case my sons/daughters wardss progress in studies in uniformly poor in the Institution, his/her studies are liable to be terminated by the issue of Transfer Certificate. That in case my son/daughter/ward becomes a scholarship holder or comes to enjoy educational concessions like half-fee, or full fee, etc. and does not show special progress, the scholarships or educational concessions are liable to be cancelled and that if my sons/daughters/wards conduct and character are not good these will be cancelled. That my son/daughter/ward is aware that breach of discipline and rules or bad conduct in the extracurricular/co-curricular activities will also entail forfeiture summarily of seat in the Institution, in addition to such other proceedings that may be taken against him/her. That I am aware that if my son/daughter/ward is admitted into the hostel he/she will strictly abide by the rules and regulations in force in the hostel and that any breach of discipline or rules or any unruly conduct or undesirable activities will be summarily dealt with by forfeiture of seat both in the hostel and in the Institution in addition to such other proceedings that may betaken against him/her.

10. I am aware that if my son/daughter discontinue his/her studies, I agree to pay the balance fee of remaining years. 11. I agree to remit the transport fee either from Nagercoil or Tirunelveli by one or two instalments in a year at the beginning of each semester. 12. I am aware that Fees once paid will not be refunded 13. I am aware that ragging within or outside the college is prohibited and students who involve themselves in ragging shall be punished with imprisonment for a term, which may extend to 2 years and shall also be liable to a fine, which may extend to ten thousand rupees. 14. I am aware that the tuition fee, special fee and other fees should be paid within 15 days from the date of beginning of odd semester, and failure to do so on my sons/daughters wards part would entail forfeiture summarily of his/her seat in the Institution. 15. I agree to abide by the rules and regulations of the college and hostel. Signature of the Parent/ Guardian Name : I also give my consent to the above declaration Signature of the Student Name : 16. List of Documents/Records enclosed: Sl.No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Documen/Record Xerox/Original Transfer Certificate Conduct Certificate S.S.L.C.Mark Sheet H.Sc Mark Sheet Community Certificate Provisional Certificate Consolidated Mark Sheet Degree Certificate Diploma Certificate Course Completion Certificate Migration certificate (For other State only) Physical Fitness Certificate 6 copies of recent colour Passport size Photograph Others Enclosed Yes/No Remarks

17. List of Documents required for NRI Quota to be enclosed

Sl.No. Document/Record 1. 2. 3. 4. 5. 6. 7. 8. Sponsorship Letter(In Original) Relationship Certificate Employer Letter (in Original) Embassy Letter (in Original) Non Resident External(NRE) Bank Account Statement Evidence for the Payment of Development Charges of US $ 2500/- (in Demand Draft) Copy of valid Indian Passport of Sponsor Nativity Certificate of Sponsor


Enclosed Yes/No.

Remarks (Official Use only)

*Subject to approval FOR OFFICE USE ONLY (To be filled by the verification officer of the College) Name of the student : College Allotted Date : : Signature of the parent Name : Degree : Branch : Quota : Signature of the verification officer Name:

Signature of the student Name : FOR OFFICE USE ONLY

Sl.No. 1. 2. 3. 4. 5.

Particulars Completion of Application Qualifying Examination Marks Qualifying Certificates List of documents enclosed Declaration/Joint Declaration of student & parent

Verified by

PSN Group is committed to ensuring the policy and security of personal information.

For more details refer to out privacy policy at