Other UG/PG Courses Admission Form – Jai Bharath Arts & Science College

Name of the course applied for*

1. a)Name of the candidate:*

b) Address to which communication are be sent:

Door No / House Name:*

Area/Street/Road:*

Post Office:*

District & State:*

Phone No. with area code:*

Mobile number:*

Pincode:*

Email Id:*

b) Permenent address of the candidate if different from above

Door No / House Name

Area/Street/Road

Post Office

District & State

Phone No. with area code

Mobile number

Email

b) Nationality:
IndianOther

e) Gender:
MaleFemale

f) Religion:

g) Caste:

h) Blood Group:

2. Date of Birth:

3. Details of exta carriculam activities:

4. Achivements attained:

5. Details of scholarships/ award obtained :

6. a) Name of Parent/Guardian:

6. b) Address of Parent/Guardian:

Contact No (Tel/Mob):

e-mail address if any:

c) Occupation of Parent/Guardian :

d) annual income of Parent/Guardian :

7. Are you native of Kerala?
YesNo

8. a) Name of qualifying examination [BA/B.Sc/B.Com/B.Tech etc] Appeared/Passed

b) Name of University or Board:

c) Register Bo./Month/Year:

d) Name of Institution in which studied:

e) Number of chances availed for the qualifying examinations :

9. Are you an employee? Details of your employment?

10. Any other feature for special consideration?

11. Reservation particulars

Are you eligible for reseravtion under any category
YesNo

If yes, specify Community /Category [Management Quota/SEBC/SC/ST/any Other(specify)]: