Application No.: N

DIRECTORATE OF OPEN AND DISTANCE LEARNING TAMIL NADU AGRICULTURAL UNIVERSITY, UNIVERSITY COIMBATORE – 641 003

Application form for admission in PG Degree / PG Diploma / Diploma through Distance Education To be filled in by the candidate 01.

Name of the applicant (IN BLOCK LETTERS)

:

__________________________________

02.

Name of the Parent / Guardian / Husband

:

__________________________________

03.

Address for communication

:

__________________________________

Affix recent passport size (colour) Photograph

__________________________________ __________________________________ Phone:______________

Mobile: Mobile:____________________

District :______________________________ __________

e-mail: ___________________________

Pincode :

04.

Date of Birth : Day

05.

Sex :

06.

Mother tongue : __________________________________________

07.

Social category :

SC

ST

BC

OBC

Others

09.

Employment status

Govt.

Private

NGO

Self employed

Others

Year

Female

Male

If employed 08.

Month

a.

Age

Transgender

Designation: __________________________________________________________

Registration sought for: PG Degree

M.B.A (Master of Business Administration)

M.Sc. (Environmental Management)

M.Sc. (Sugarcane Technology)

PG Diploma

Production and Quality Control in Medicinal Plants

Food Biotechnology

Bioinformatics

Plant Quarantine

Energy Management

Food Science and Processing

Eco-friendly friendly Pest Management

Diploma

10. Sl. No

Multimedia

Preferred session

a. week days

[Timings: as per the discretion of the Director]

b. week ends

Educational Qualification *: Educational Qualification

Name of the institution

Year of passing

Main subjects

% of Marks & CGPA

01. 02. (Attested ttested Xerox copy of the proof of educational qualifications should be enclosed)

Class

11.

Details of work experience if employed or self employed **:

Name of the Organization / Employer

Designation

Period From

To

Total Years

Nature of duties

(** if employed, employers certificate may be enclosed) 12.

Course fee (Course fee is not refundable and transferrable) Online payment Ref. No. _____________ Amount:____________ Date: ___________ Bank:________________

13.

Candidate’s declaration: I hereby declare that the information stated in the application form is true, complete and correct to the best of my knowledge. I hereby abide by the rules and regulations of the TNAU on the event of my admission.

14.

Sources of information:

Newspapers

Magazines

Media

Friends

Others:

Signature of the applicant Place: Date: For Office Use only 01.

Candidate’s Permanent Registration No.:

02.

Programme:

03.

Subject:

PG Degree:

M.B.A / M.Sc. (Environmental Management) / M.Sc. (Sugarcane Technology)

PG Diploma: Production and Quality Control in Medicinal Plants / Food Biotechnology / Bioinformatics / Plant Quarantine / Input Dealers / Energy Management / Food Science and Processing / Eco-friendly Pest Management Diploma:

Fees Paid

Multimedia

04.

Programme :

Amount Rs. ____________________________

05.

The fees to be paid only through Online mode: https://www.onlinesbi.com/prelogin/institutiontypedisplay.htm Online Ref. No. _____________ Amount:____________ Date: ___________ Bank:________________

Verification and Admission Certified that I have verified all the certificates in originals and DD for Registration fee

Signature and Address of the Verification Officer

Director (ODL)