Application No *

Registration No *

Date *

2. Father/Guardian name *

3. Mother's name *

4. Date of Birth (As in the HSC) *

5. Age *

6. Sex * Select Male Female Others

7. Blood group *

8. Father/Guardian/Mother's occupation *

9. Nationality *

10. Religion *

11. Community *
  SC     ST     MBC     DNC     BC     BCM     OC  

14. If you are physically handicapped specify *
  Yes     No  

15. Are you tamil origin from Andaman Nicobar Island *
  Yes     No  

16. Are you a daughter of Ex-Service man *
  Yes     No  

17. Distinction in NSS/NCC *
  NSS     NCC     No  

18. Distinction in Sports *
  School     District     State     No  

19. Do you want hostel facility *
  Yes     No  

20. Do you want bus facility *
  Yes     No  

21. Name of the school last studied *

21a. Location of the school *

22. Bank Name *

22a. Account No *

22b. IFSC code *

II. ACADEMIC DETAILS

1. Qualifying examination passed *
  HSC     CBSE     OTHERS  

3. Overall percentage of marks *

DECLARATION BY THE CANDIDATE   I hereby declare that the particulars given above are true and correct to the best of my knowledge. I accept that my admission is provisional, subject to the approval by the Thiruvalluvar University. I agree to abide by the Rules and Regulations of the College regarding academic and related activities. I understand that in matters pertaining to the breach of discipline or non-observance of rules and regulations the decision of the College authorities will be final and binding on me.

UNDERTAKING BY THE PARENT / GUARDIAN   I, ,do hereby assure you that my daughter/Ward if admitted to the Islamiah Women's Arts & Science College, Vaniyambadi, Will not take part in any activity prejudicial to the intrest of the College. I undertake to pay regularly the fees due to college till the completion of the course and assure that I shall abide by any disciplinary action decided by the College authorities in case of any contravention of the above agreement. In the event of daughter / ward leaving the college midway I will pay the whole fee for the entire course and claim no refund. I also understand that legal action is warranted against my daughter / ward if she is found indulged in Ragging.