FFForororm No. 136 UNIVERSITY OF KERALA Application for Pre-Registration (Please read the instructions in page 3 & 4 before filling up the form) AAA. General Details 1. Name of the Course A passport 2. Specialisation 3. Course Code size Photograph to be attested by the Head of the Institution 4. Name of the Institution (use abbreviations, if needed) 5. Admn. Year 6. Institution Code Signature of the Candidate B. Personal Details 7. Name of the Candidate (leave space between words) 8. Date of Birth (DD - MM - YY) 9. Sex (F/M) 10. Religion 11. Community 12. Reservation Catagory (‘C’-SC, ‘T’-ST, ‘B’-OBC, ‘O’-Other reserved category, ‘N’-No reservation) 13. Communication Address (leave space between words) Pin 14. Phone No. with STD Code (if any) 15. e-Mail Address (Use one column for each character) Other Reservation Categories (Give P mark in appropriate columns) 16. Sports 17. Ex-Service/Dependent 18. Handicapped 19. Repatriate 20. NCC 21. NSS 22. Teaching Experience 23. If yes for (22), give length of service (If in regular service in Govt. / Aided Institutions) Year Month C. Qualifying Examination Details 24. Name of Course 25. Specialisation / Group 26. Name of the Institution (use abbreviations, if needed) 27. Course Code 28. Course Type 29. Institution Code 30. Institution Type 31. University / Board 32. Register No / Candidate Code 33. Scheme Code 34. Sem/Year 35. Exam Month 36. Exam Year D. Details of Marks of Qualifying Exam (read instructions for section D carefully) Subjects Marks awarded Maximum Marks 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. Class / Division 65. GPA / Percentage 66. Whether Original Certificate attached (Y or N) 67. Have you been given any ID-number earlier (Y / N) If Yes, give details in (68) and (69) 68. Course Code 69. Temporary ID alloted E. Fee Details 70. Eligible for fee concession (Y or N) 71. Draft No / Chalan No. 72. Date of Payment (DD MM YY) 73. Name of the Bank or Friends / Cash Counter 74. Amount Rs. 75. Location of the Bank or Friends / Cash Counter FFF... Matriculation Details 76. Institution last attended 77. Valid Matriculation Order No. (of Kerala Univeristy) 78. University affiliation of Institution ( If applicable) 79. Date of Matriculation Order ( If applicable) DECLARAAATION CERTIFICATE I hereby declare that the entries made in this application form are I hereby certify that the information furnished by the candidate in true to the best of my knowledge and that they have been made this application has been verified by me and that I have found them to agree with the records available in this office. The candidate in my own hand writing. has a valid matriculation in this University with Matriculation No. dated ............... Place : Date : Date : Signature of the Applicant Signature of the Principal Office seal 2 Design & Typesetting by K.U.C.C Instructions to fill up Application form (form No.136) Use one column for each character. If number of columns is insufficient, use abbreviations already in use or mention only the first three letters of each word with a blank space in between. AAA 1. Give the name of the course to which you are admitted. Eg: For MSc M S c 2. Give the specialization of the course to which you are admitted. Eg. For Physics P H Y S I C S 3. Give the code of the course to which you are admitted. Course Code is a three digit number representing each course under Kerala University. See Table -1 attached. 4. Eg. For Sree Narayana College, Kollam S N C O L L E G E K O L L A M 5. Admission Year - Indicate the last two digits of the academic year of admission of the candidate to the present course. 6. Institution Code - See the Table-2 for Institution Codes. BBB 7. Give the name as in the certificate of qualifying examination. Leave space between adjacent parts of the name. Eg. For SMITHA S DHARAN S M I T H A S D H A R A N 8. The format is DD MM YY Eg:- 24 May 1980 as 2 4 0 5 8 0 9. Write M or F as applicable in the box space provided. 10. Give your religion. 11. Write the community you belong to. 12. Categories eligible for reservation should mention the respective code here. ‘C’, ‘T’ and ‘B’ are for SC, ST and OBC . Other categories eligible for reservation should indicate ‘O’ . Those who are not under reservation category should indicate ‘N’. 13. Write your communication address leaving space between words. Pincode should also be written. 14. Give your phone number, if any. 15. Give your e-mail address. 16-22 Put tick marks in columns which are applicable. Item No.22 is applicable only to candidates admitted based on teaching experience also. 23. If you have teaching experience, give length of service. CCC Details of the examination which makes the applicant eligible for the course applied for. 24. The qualifying course on the basis of which the candidate is seeking admission. eg : BA or BSc 25. The specialization of the qualifying course. eg: ECONOMICS If the specialisation needs more than twelve characters mention only the first three letters of each word of specialisation separated by blanks. Eg: MANAGERIAL ECONOMICS can be written as M A N E C O 26. Give the name of the institution in which the candidate studied for the course. Item Nos 27-30 are applicable only to those candidates who have passed the qualifying course from Kerala University. 27. This item is applicable to those applying for PG courses only. Write the code number of the qualifying course. See Table -1 attached. 28. This item is applicable to those applying for PG Courses only. Write ‘1’ for course having one main and two subsidiaries, ‘2’ for two main course, ‘3’ for three main course, ‘4’ if all subjects are of equal importance ‘5’ if final year subjects are of equal importance & ‘6’ for others. 29. This item is applicable to those applying for PG Courses only. See Table-2 for Institution Codes. 30. This item is applicable to those applying for PG Courses only. Write ‘1’ if the candidate has completed the qualifying course in a University Department, write ‘2’ if Affiliated College ‘3’ if Study Centre under Distance Education Scheme of Universities and ‘4’ if others. The applicant who completed the course under Distance Education Scheme in a study centre which is also an Affiliated College under any University shall indicate ‘3’ against item no. 30. 31. This item is applicable to those applying for PG Courses only. Write name of the University from where the candiate passed the qualifying examination. 3 32. Register Number / Candidate Code of the candidate in the qualifying examination. 33. For candidates seeking admission to graduate courses, write ‘01’ for Plus II, ‘02’ for CBSE and ‘03’ for ICSE, ‘04’ for Pre- Degree, ‘05’ for Diploma and ‘06’ for others. For candidates seeking admission to Post-graduate courses, give the last two digits of the year of introduction of the scheme in which the candidate passed the qualifying examination from the respective University. 34. Write ‘S’ if semester system was followed for the qualifying course and ‘Y’ if yearly system was followed for the qualifying course. 35. Month of qualifying examination. 36. Year of qualifying examination. The last two digits of the year of qualifying examination should be written. eg. 01 or 02 for 2001 and 2002 respectively. D. Details of how to fill up mark details This section gives provision for filling up the marks obtained in 9 different Groups. Each row is meant for a group. For eg. A chemistry graduate applying for the MSc Course will fill up the rows as follows. English, Second language, Main subject & each of the subsidiary subjects are considered separate groups. WWWrite the subject name (viz ENGLISH) against item no.37, total marks secured for all the papers in ENGLISH against item no.38 & maximum marks for ENGLISH against item no.39. Similarly write the subject name of Second Language (eg. Malayalam, Hindi ...) against item no.40 and so on. Subjects Marks awarded Maximum Marks 37. E NG L I S H 38. 1 5 0 39. 3 0 0 40. M A L AYA L A M 41. 1 2 0 42. 2 0 0 43. C H E M I S T R Y 44. 2 4 0 45. 6 0 0 46. M A T H E M A T I C S 47. 1 5 0 48. 2 0 0 49. P HY S I CS 50. 0 8 0 51. 2 0 0 52. 53. 54. 64. Enter ‘D’, ‘F’, ‘S’, or ‘T’ for Distinction, First, Second or Third. 65. Give GPA or Percentage of marks obtained by the candidate in the qualifying examination. 66. Write ‘Y’ if original certificates are attached and ‘N’, otherwise. 67. Write ‘Y’ if the candidate has applied for pre-registration and received temporary ID earlier from this University and ‘N’, otherwise. 68. If the candiate had been given temporary ID number earlier from this University, give the code of the respective course joined earlier. See Table-1 for course codes. 69. Give the temporary ID alloted to the candidate . E.E.E. Fee can be remitted either by cash at University Cash Counter/ ‘Friends’ counters or by Demand drafts drawn in favour of “““The Finance Officer, University of Kerala, Thiruvananthapuram”.