ANDHRA UNIVERSITY

DIRECTORATE OF ADMISSIONS Form - III

APPLICATION FORM FOR ADMISSION INTO
P.G. DIPLOMA AND DIPLOMA COURSES-2019
Note: (i) Read the Information Brochure carefully before filling the application form. Registration No.
(ii) Separate application with D.D. has to be applied for each course.
Particulars of Demand Draft(s) enclosed towards registration fee (Rs.500/-)
D.D.No. _____________ Date: ___________ for Rs. __________ Bank: __________
1. Course Code &
Name of the course :
2. Name of the Applicant (IN CAPITAL LETTERS):

SURNAME FULL NAME Attested Photograph

(taken not earlier

than 1-6-2019)

Father's Name ....................................................................................................................

Mother's Name ....................................................................................................................

Address .................................................................................................................... 3. Gender : (put

P mark)
.................................................................................................................... Male Female

PIN:.........................Tel. No. with STD Code ........................................

4. Date of Birth
Mobile No.: .................................... E-mail: ............................................
5. Reservation Category : Day Month Year
Put P mark in appropriate box (Enclose attested copies - See Information Brochure)

LBC EWS EWS 6. Minority Community towhich

SC ST
A B C D E Kapu Others you belong (Put mark)
7. Category (put
P
mark) P
Muslim Christian Any other Local Non-Local Other State

8. Details of academic record: (a) Details of Qualifying Examination:

Name of the Overall % of Marks
Branch University Year of Passing (all years of study)
Qualifying Exam.

9. Particulars of Marks obtained:

Year of Marks Maximum % of
Years of study College / University
Passing scored Marks Marks
IX
S.S.C

Inter 1st Year

2nd Year

First Year I-Sem.

II-Sem.
I-Sem.
Second
Year II-Sem.
I-Sem.
Third Year
II-Sem.
Fourth Year I-Sem.
(if any)
II-Sem.

DECLARATION BY THE CANDIDATE

The particulars furnished above are true and correct to the best of my knowledge and I here by agree for the
cancellation of my application / admission if any of the above details are found to be false.

Signature of the Parent / Guardian. Signature of the Applicant.