SRIMATHI SUNDARAVALLI MEMORIAL ARTS AND SCIENCE COLLEGE

New Perungalathur, Chennai - 600 063

Registration Form

Personal Details

________

Name of the Student*

Date of Birth*

Gender*
Male Female

Differently abled person*
Yes No

Religion*

Nationality*

Community*

Residential Address*

Residential Pincode*

Student Mobile No.*

Student Email ID*

Student Aadhaar No.*

Course Preferred 1*

Course Preferred 2*

Course Preferred 3*

Class X Details

________

Name of the School*

Board*

Medium*

Year of passing*

Mark obtained*

Percentage/CGPA*

Class XII Details

________

Name of the School*

Board*

Medium*

Year of passing*

Mark obtained

Percentage/CGPA

Father Details

________

Name*

Mobile No.*

Email ID*

Mother Details

________

Name *

Mobile No.*

Email ID*

Other Details