SHRIMATHI DEVKUNVAR NANALAL BHATT VAISHNAV

COLLEGE FOR WOMEN(Autonomous), Chromepet, Chennai 600044

Online Application Form for UG Courses in Aided Stream (Day College)
(Note: This document is only a snapshot of online application. You can fill the online application in the website
after the publication of +2 results.
Rows marked with * are compulsory
Course : * *

Academic Year : 2017-2018

+2 Exam Register Number: *

Applicant Name : (as in +2 marksheet) *

E-Mail ID :*

Mobile Number :* +91

Language Opted in College : *

(HINDI/TAMIL/SANSKRIT)
Hostel Accomodation Required? (yes/no) : *
Personal Details
Date of Birth : * (dd/mm/yyyy)
Blood group :

Nationality : (Indian/others) *
Religion(hindu/Christian/muslim/sikh/jain) *
(oc/bc/bc muslim/mbc/sc/sc arundathiar/st)
Community & Caste : *

Father's Name : *
Mother's Name : *

Parent Address : *

City : *
Pin Code : * Landline Phoneno.:

State *
Occupation of Parent : *
Annual Income (enter without comma) *
Native Place *
Guardian Name (if any): :

Guardian Relationship : :

Guardian Address :

City:
 Pin Code : Guardian Phone :

Special Reservation
Differently abled (yes/no)
(if yes then type and percent details) *
Daughter of Ex-service Man (yes/no) *
Tamil Origin from Andaman Nicobar
/Srilanka *
district/ State/national/international
Sports (yes/no)
(if yes then name of the game and level) *

Extra Curricular
NSS (yes/no)

NCC (yes/no)

Other Extra-curricular

Higher Secondary School Details

Medium of Instruction in +2 (English/Tamil) *
Stream in +2 (Academic/Vocational) *
Board: (STATE/CBSE/ISE) *
Name of the school studied in class 12 : *
School Code ( for CBSE)
Address of School :
District of School
(kanchipuram/Chennai/thiruvallur/others) If Others, Specify

For state board enter marks for maximum marks 200, CBSE & ICSE for maximum marks 100.

Maximum Month/Year
Subject Marks No. of Attempts
Marks of Passing (mm/yyyy)

Part I
(Language)
PART II English

1.

2.
PART III
(major) 3.

4.

DECLARATION
1. I declare that all the particulars above are true and correct
2. I have read the prospectus completely

3. I admit that I will abide by the rules and regulations of the college

PREVIEW DETAILS BEFORE SUBMIT