UNIVERSITY OF KERALA CENTRE FOR CONVERGENCE MEDIA STUDIES Senate House Campus, Palayam, Thiruvananthapuram - 695 034 Phone : 0471-2301045/2306422 - Extn. 432 (O), e-mail :
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; www.ccms.keralauniversity.edu APPLICATION FOR ADMISSION TO CERTIFICATE IN TECHNICAL COMMUNICATION (January 2008 Batch) IDENTITY CERTIFICATE I certify that the photo is that of .................. Photo Signature Name and address of the Identifying Officer (Office Seal) (To be signed on the Photograph) 1. Name in full with initials (in block letters) 2. Expansion of initials 3. Sex 4. Age & date of birth 5. Place of birth with taluk, district 6. Religion and Caste (Specify whether you belong to SC/ST/OEC/OBC etc.) 7. Annual Income of Parents / Guardian 8. Permanent address (The address should contain pin code, phone numbers and e-mail ID) 9. Address to which correspondence may be made 10. Name & address of local guardian 11. Details of qualifying examination passed & marks secured a. Name of the examination passed with Reg. No. & Year b. Name of University c. Address of college where the candidate has studied for degree course d. Is it a course under the annual scheme or a semester programme ? e. Details of marks secured Title of the subjects / papers Marks secured Maximum marks Register No. & Year Pass percentage Grand Total 12. Any other information you wish to add in support of your application DECLARATION I, .......................... do hereby declare that the information furnished above is true to the best of my knowledge and belief. Place : Signature of applicant Date : Countersigned by the guardian FOR OFFICE USE ....................... a candidate for CTC Entrance Test ................... has been ranked ........ ..................... in the Merit List / Community List / Wait List ..................... She / He has been admitted to CTC Course HON. DIRECTOR, CCMS Date : UNIVERSITY OF KERALA CENTRE FOR CONVERGENCE MEDIA STUDIES Senate Campus, Palayam, Thiruvananthapuram - 695 034 Phone : 0471-2301045/2306422 - Extn. 432 (O), e-mail :
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; www.ccms.keralauniversity.edu APPLICATION FOR ADMISSION TO CERTIFICATE IN TECHNICAL COMMUNICATION (January 2008 Batch) Roll No. (to be supplied by office) ADMIT CARD Note : Candidates are advised to preserve this admit card till the admissions are over Name of candidate (Block Letters) Full postal address of the candidate SIGNATURE OF CANDIDATE Name of attesting officer Designation & Address Photo Please get attested by signing over the photo by a Gazetted Officer I certify that the Photo is that of .............. (FOR OFFICE USE) Venue of Examination : Date of Examination : Time : (You are provisionally admitted to the Entrance Examination subject to your eligibility to be determined in due course) HON. DIRECTOR, CCMS
