2. Name in CAPITAL LETTERS (In English): (as in Educational certificate)

3. Father’s Name / Husband’s Name in CAPITAL LETTERS (In English):

PASSPORT SIZEPHOTO

duly signedand attested

by an authorisedOfficer

APPLICATION NO.

ROLL NO.

FOR OFFICE USE ONLY

Dist.

State

Phone No.(with STD Code)

PIN

E-mail ID Mobile No. :

6. Date of birth (in the Christian era) (as entered in the School Leaving Certificate)

7. Sex: Male Female 7. Nationality:

8. Religion: Hindu Muslim Christian Others (specify)

9. Community:

Date Month Year

91

SC ST MBC BCM DNCSCA BC OC

ANNAMALAI UNIVERSITY

In Collaboration with

1. Programme 2 1 3 Hypnotherapy Code & Name

Counselling and

Medium : ENGLISH

4. PERMANENT ADDRESS IN CAPITAL LETTERS (to which communications and lessons are to be sent)

Rajyoga Education & Research Foundation, Madurai

APPLICATION FOR ADMISSION TO

Reg. No.and Year

Percentageof Marks

ClassObtained

Name of theExamination

Name of theUniversity/Board

Duration ofProgramme

10. Qualifying Examination Passed:

Application Fee : Rs. 100/ - in person and Rs. 150/- by post

Academic Year : 2015 - 2016

PG Diploma in

Place:

Date: Signature of the Applicant

i) I declare that the particulars given above are correct and I submit myself to the disciplinary and regularly jurisdiction of the authorities of

the University who are vested with the rights to exercise discipline under the Act, the Statutes, and the Ordinances, and will strictly observe

the rules and regulations that have been framed thereunder by the University.

ii) I hereby agree that with regard to disputes arising in all matters including admission, returning of original certificates after verification,

sending of lessons, classes, response sheets, examinations, remittance of fees, etc., only the Courts and Tribunals having jurisdiction over

Annamalainagar (Chidambaram), Cuddalore District, Tamilnadu and not over any other place, shall have jurisdiction for the purpose of filing a

suit or preferring complaint under the Consumer Protection Act or any other law for the time being in force or for taking any legal action against

the Co-ordinator (Oncampus Programmes), D.D.E., Campus or the Controller of Examinations, Annamalai University.

DECLARATION

12. Occupation: Government Non-Government Others

13. Are you presently undergoing any

other programmes, in any institution Yes No

(including DDE)? If yes, give details :

Official-in-Charge The Programme Co-ordinator The Programme Director

Official-in-Charge Section Head

Admission Confirmed

11. Pattern of passing 11+1+311+2+2 10+2+3

(Direct OUS, UG, PG Degree are not Eligible)the Degree Examination:

Enclosures: (1) Photostat Copy of (Check List)

Degree Certificate/Pass / Provisional Certificate

(2) Photostat Copy of Mark List or Consolidated Mark List

(3) Photostat Copy of Transfer or Migration Certificate

(4) Identy Card duly filled in

(6) Photo Copy of Community Certificate (Except OC)

(5) Scanning Slip

(Do not enclose original certificates)

REMITTANCE PARTICULARS

2) Transfer OR Migration Certificate Draft/Challan Number :

3) Mark List (10th/12th Standard) Amount :

FOR OFFICE USE ONLY ELIGIBLE NOT ELIGIBLE

Provisionally selected for admission. Spot selection subject to confirmation by the Director

Name of the Bank :1) Degree/Provisional/Pass Certificate

Date :4) 8th Standard Transfer Certificate

5) 10th Standard Transfer Certificate

CERTIFICATES VERIFIED

Co-ordinator(On-Campus Programmes)

CHECK LIST 

While sending filled up Application please  ensure the following : 

1.    For PG Diploma VE&S / M.B.A/M.Sc.,(2 Years)/ PGDVIHC/PG Dip in Counselling & Hypnotherapy 

   a) One Degree Certificate (Xerox copy duly attested by a Gazetted Officer, either provisional or Degree Certificate). 

   b) Final Mark sheet consolidated / 3 Years Mark sheet  (Xerox copy duly attested by a Gazetted Officer) 

   c) One Certificate to verify your name and Date of Birth (Xerox copy of Transfer Certificate /10th or 12th  Mark sheet   

         duly attested by a Gazetted officer). 

 

     For  Diploma in VE&S  

a) One +2 or equivalent Certificate/Mark sheet (Xerox copy duly attested by a Gazetted Officer) 

b) Transfer Certificate to verify your Date of Birth (Xerox copy of duly attested by a Gazetted officer) 

   For M.Sc.,(L.E)) 

a) PGDVE&S Provisional/Convocation  and Mark sheet (Xerox copy duly attested by a Gazetted Officer) 

 

2.    One Passportsize photograph to be affixed and duly attested by a gazetted officer on the application form. 

        Two passport size photos should be enclosed along with the application. 

   

3.    Demand draft  favouring The Director,DDE,Annamalai University payable at Chennai from any bank. 

For Diploma in VE&S  Rs.2500/‐ 

For PG Diploma in VE&S   Rs.4500/‐ 

For  M.Sc.,(L.E)  Rs.8500/‐ 

For M.Sc.,(1st  year)  Rs.4500/‐ 

  Please don’t forget to write your name & Course code on the back of the DD drawn . 

 

4. Please send your application along with the  enclosures to the following address and not directly to the  

    Annamalai University. 

The Admission Division, AU Nodal center, Brahma Kumaris,RE&RF, 36,Meenakshi Nagar, MADURAI – 625017. Mob: 09442268660. 5. The university will confirm the receipt of the application form through SMS,if you provide your Mobile number. 

M.B.A  Rs.14500/‐ 

PG Dip.in Values in 

Healthcare 

Rs. 4500/‐ 

PG Dip.in  Counselling & 

Hypnotherapy 

Rs. 6500/‐