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Application form for Admission to BA BHARATHANATYAM /KARNATIC MUSIC
Reg .No
Centre of study: LASYA COLLEGE OF FINE ARTS, PILATHARA.
Codes
Reservation
1. Name with initials (in block letters) :
2. Expansion of initials:
3. Sex : 4. Nationality : 5. Date of Birth :
6. Place of birth : Taluk: District:
7. Religion & Caste: 8. Marital Status:
9. Details of the guardian of the applicant
Name:
Occupation :
Relationship:
Whether literate: Yes/ No.
10. Address to which communications are to be sent
Present Address Permanent Address
Land Phone with STD code:
11. Details of institution which the applicant last studied :
Class: Year:
Name of the institution: University:
12. Number of chances ( excluding betterment ) the applicant has appeared for the qualifying examination:
13. Do you have an NCC certificate signed by the Director and issued by the directorate of NCC? If so
give details ( NCC – B / NCC –C):
14. Do you have an NSS certificate signed by the Vice – Chancellor and issued by the University? If
so , give details:
15. * Are you a Physically handicapped person? If so, give the nature of handicap:
* Attested copies of certificates supporting the claim should be attached)
16. Have you represented any University/State/ Nation in any of the games/ sports items? * If yes, give details:
( * A copy of the application and copies of the certificates supporting the claim may be submitted to the
Dept. of Physical Education)
17. * Do you require accommodation in approved hostels?
( * For girls only)
18. Details of the qualifying examinations:
Reg. No.: Month: Year:
19. Details of Marks/Grade obtained
(I)For students with marks:
Marks Awarded Max. Marks
Part 1 ( English )
Part 2 ( Second Language )
Marks Awarded Max. Marks
Main:
Sub 1 :
Sub 2 :
Total
(ii)For students with Grade ( 2008 Admission – Kannur University )
Details of Weight and Grade Points of Part 1 and Part 2 subjects
Weight Grade Point SGPA
Part 1 ( English )
Part 2 ( Second Language )
CGPA Grade
Details of Weight and Grade Points of Main and Subsidiary subjects
Weight Grade Point SGPA
Main :
Sub 1 :
Sub 2 :
Total ******
DECLARATION
I hereby solemnly affirm that the information given above in the application are true to the best of my
knowledge and belief.
Signature of the applicant
Place :
Date: Signature of the parent/ guardian
TO BE FILLED IN BY THE OFFICE
Initial Index (II)
Grace Score (G)
Bonus Score (B)
Handicap Score(H)
Final Index FI(=II + G+B-H)
Index Mark (in the case of Mark System)
Remarks:
Prepared by : Checked by :
Admit
Admission No.:
Date of Admission:
PRINCIPAL
NB: An applicant who secures admission on the basis of wrong or false information supplied will forfeit the seat
will be removed from the rolls of the college. Applicant should have satisfied the eligibility criteria prescribed
the University.
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