Application fee transaction ID/Number

Name of applicant

Photograph of applicant (JPEG or PNG format/ max.file size 100Kb only)

Address of applicant

Contact Number

Alternate Number

Date of birth

Place of birth

GenderMaleFemaleTransgender

Taluk & District

Nationality & Mother Tongue

Community to which the applicant belongsSCSTOBCOTHERS

Religion

Caste

If Catholic, state whether
Syro MalabarLatinMalankara
Whether child to Ex-service man or JawanYesNo

a)If member of N.C.C.YesNo
(b)Whether certificate holder of N.S.S. YesNo
(if eligible for weightage attach copy of certificate)

If sports person. of which level ((attach copy of Certificate)NationalStateDistrictNone

If differently abled, state whether (attach copy of Medical Certificate)BlindDeafOrthopaedicBrain diseasesNone

Name of qualifying Examination passed

Subject selected for Degree ArtsScienceCommerce

Number of times appeared for qualifying examination

Summary of Marks in the qualifying Examination (Attach copy of Marklist)

Course Opted
MA English Language & Literature

Name of the qualifying examination

Register No. and Year

Percentage of Marks

Reason(s) for break of study, if any

Proficiency in extra-curricular activities with details

If any of the parents of the applicant was a student of Christ Nagar, give details,including present address

Does the applicant receive any military or other concession or scholarship- Specify

Do you need College Bus facility ?YESNO

If “YES”, name the Boarding Point

Name and address of Parent / Guardian

Occupation and annual income of Parent / Guardian

Relationship with the applicant

Telephone No. with code

Mobile No. to be registered for SMS

DECLARATION All the facts stated above are true and correct to the best of my knowledge, information and belief.