Application No.
ANAND INSTITUTE OF HIGHER TECHNOLOGY
An ISO 9001:2008 Certified Institution and Accredited by NBA
Approved by AICTE, New Delhi, [Link] Tamil Nadu & Affiliated to Anna University, Chennai
Kalasalingam Nagar, Rajiv Gandhi Salai, Kazhipattur, Chennai - 603103, Tamil Nadu.
Tel : 044 - 27471330 / 27471320 Telefax : 044 - 27471310 / 27471320
E-mail : aiht_anand@[Link] Website : [Link]
APPLICATION FORM
FOR ADMISSION FOR THE ACADEMIC YEAR 2021 -2022
Name of the Course : .......................................................... Quota : Govt. Management
Date of Admission : ...................................
Name of the Applicant : ..............................................................................................
Father's Name : ..............................................................................................
Passport Size
Mother's Name : .............................................................................................. Photograph
Date of Birth : ..............................................................................................
Sex : Male Female
Community : OC BC BCM BCC MBC DNC SC SCA ST
Caste : .....................................................................................
Annual Income of Parent as per Income Certificate :.............................................................................................................
Annual Income of Parent Designation Office Address
Father : ................................................ ..................................................
..................................................
Mother : ................................................ ..................................................
Residential Address Door No................ Flat No................. Plot No...............
Street : ......................................................................................................
Village / Town : ......................................................................................................
Post / City : ......................................................................................................
Taluk : ......................................................................................................
District : ......................................... Pincode
Mobile No. Father :................................ Mother : .....................................
Residence Phone No. : ............................................ Guardian :...................................
E-Mail : ..................................................
For Day Scholar (Boarding Point of College Bus) :..............................................................................
Hostal Accommodation Required : YES NO
1. Mother Tongue : ...............................................................................................
2. Name of the Guardian and Address : ...............................................................................................
...............................................................................................
Note : Address of Guardian should be ...............................................................................................
given only when both the parents are Phone No. ..............................................................................
not alive Mobile No...............................................................................
(b) Local Address for Outstation Candidates : ...............................................................................................
...............................................................................................
Phone No. ..............................................................................
Mobile No...............................................................................
3. Proficiency in Sports, Games and N.C.C. : National State District College / Institution
Represented Sports, Games and N.C.C. : National State District College / Institution
4. Place of Birth (Village / District / City) : ...............................................................................................
5. Civic Status of your Native place : Rural / Panchayat / Municipality / Corporation / Metro
6. Native District and State : ...............................................................................................
7. Are you a citizen of India : ...............................................................................................
8. Extra - Curricular Activities : ...............................................................................................
(Original Certificates must be produced at the time of admission. Give details against each item)
9. Academic performance
[Link]. Name of the School with Address Class Year of Passing
1.
2.
3.
4.
5.
5. Mother Tongue : ............................................................................................................
10. Qualifying Examination :
HSC HSC HSC ISC Diploma/Degree Others
(Academic) (Vocatonal) (Central Board)
11. Medium of Instruction : Tamil English Others
12. (a) Details of the qualifying Examination :
Reg. No. ............................................. Year of Passing .........................................................................
Name of School / Polytechnic.................................................................................................................
Address :
(b) No. of appearance in the qualifying examination :
(c) (i) HSC (Academic Stream / Equivalent) (ii) HSC (Vocational)
(b) HSC (Academic / Equivalent) HSC (Vocational) Part I
Part I Tamil or Language ..................out of..................... Part I Tamil or Language ..................out of.....................
Part II English ...................out of..................... Part II English ...................out of.....................
Part III Maths ...................out of..................... Part III Maths ...................out of.....................
Physics ...................out of..................... or Physics ...................out of.....................
Chemistry ...................out of..................... or Chemistry ...................out of.....................
Elective ...................out of..................... Name of the Vocational Course.............................................
Subject Studied :
1. ...................out of.....................
2. ...................out of.....................
3. ...................out of.....................
Total ...................out of..................... Total ...................out of.....................
(c) Diploma Marks Name of the Diploma Courses
Vth Semester : VIth Semester :
Subject Marks Subject Marks
(i) .......................................................out of..................... (i) .......................................................out of.....................
(ii) .......................................................out of..................... (ii) .......................................................out of.....................
(iii) .......................................................out of..................... (iii) .......................................................out of.....................
(iv) ...................................................... out of..................... (iv) ...................................................... out of.....................
(v) .......................................................out of..................... (v) .......................................................out of.....................
(vi) .......................................................out of..................... (vi) .......................................................out of.....................
Total .......................................................out of..................... Total .......................................................out of.....................
13. For M.C.A. / M.B.A. and M.E. Admission
Degree
Discipline
University / Board
Name of the College last studied
Medium of Instruction
Month & Year of Passing of Final Year Examinations
Performance at UG Level
Semester Marks / CGPA Max No. of Month & Year % of
obtained Marks / CGPA Appearances of Passing Marks
I Year / I Sem
I Year / II Sem
II Year / III Sem
II Year / IV Sem
III year / V Sem
III Year / VI Sem
IV Year / VII Sem
IV Year / VIII Sem
V Year / IX Sem
V Year / X Sem
TOTAL
Total Marks / cumulative grades obtained from first to
last semester
Total Maximum Marks / Maximum grade points
obtained from first to last semester
Percentage
Class obtained - Major Subject
Class obtained Parts I, II and III Parts I Parts II Parts III
JOINT DECLARATION BY THE APPLICANT AND PARENT
I hereby solemnly and sincerely affirm, that the statement made and the information furnished in the application form as also in
the enclosure thereto, submitted are true, should it, however, be found that any information furnished therein is false in
material particulars or on verification at a later stage, my son / daughter / ward is liable for criminal prosecution and, I also
agree to the forfeiture of my son's / daughter's / ward's seat in this Institution at whatever stage of study my son / daughter / ward
may be at that time of detection of such wrong particulars. I also affirm,
1. That my son / daughter / ward would confirm strictly to all the rules and regulations in force now or which may be introduced in
the institution hereafter and that breach of discipline and rules by my son / daughter / ward would entail summary forfeiture of
his / her seat in the Institution.
2. That I am aware that if my son / daughter / ward does not put in a minimum of 80 percent attendance during the year, in theory,
drawing and practical classes separately, my son / daughter / ward will not be sent for the University Examination.
3. That I am aware that the curriculum for the various courses is not rigid and my son / daughter / ward will follow the syllabi during
the courses of his / her study in the Institution and will be binding on him / her .
4. That I am aware that if my son / daughter / ward does not get a minimum of 50 percent of marks in the day to day valuation of his /
her work and progress, he / she will not be sent for the University Examinations.
5. That in the case of my son's / daughter's / ward's progress in studies is, uniformly poor in the Institution, his / her studies are
liable to be terminated by the issue of Transfer Certificate.
6. That in case of my son / daughter / ward becomes a scholarship holder or comes to enjoy educational concessions like half fee
or full fee etc., and does not show a special progress, the scholarships or educational concessions arranged are liable to be
cancelled and that if my son's / daughter's / ward's conduct and character are not good these will be cancelled summarily.
7. That my son / daughter / ward is aware that any breach of discipline and rules or bad conduct in the N.C.C. or extra curricular
activities will also entail summary forfeiture of seat in the Institution, in addition to such other proceedings that may be taken
against him / her.
8. That I am aware that if my son / daughter / ward is admitted into the hostel he / she will strictly abide by the rules and regulations
in force in the hostel and that any breach of discipline or rules or any unruly conduct or undesirable activities will be summarily
dealt with by forfeiture of seat both in the hostel and in the Institution in addition to such other proceedings that may be taken
against him / her.
9. That in case the qualifications possessed by my son / daughter / ward are not recognized by the Anna University, Chennai and
by DOTE for admission to the B.E. / [Link]/ ME/ MCA/ MBA Degree Course in the Engineering College my son / daughter /
ward will discontinue the course forthwith.
10. That no requst for change to any course other than the course to which my son / daughter / ward is admitted will be made by us.
11. That the admission to the College does not guarantee admission to the hostel.
12. That my son / daughter / ward should not involve himself / herself in any activites prejudicial to the proper Conduct, study or
discipline of the college, such as refusing to accept the punishment awarded by the Principal for the late attandance or any
other infringement of rules.
13. That I am aware, Ragging is banned in this institution. If my son / daughter / ward involved or indulged in ragging in
any manner, he / she may be expelled from the institution.
14. I agree to abide without any objection or appeal to any one and to hold it as binding on me, any action or decision taken by the
Principal at his discretion or to terminate my son's / daughter's / ward's studies and to leave the college without Transfer
Certificate.
15. I agree to pay the fees fixed by the Government and self Financing and Maintenance charges fixed by the Management as per
this application.
I also agree that if there is any revision in the fee-structure at a later date, the difference in amount will be payable by me.
Station :
Date : Signature of the Parent / Guardian
I am fully aware of the declaration and I have understood the same. I agree to all the above conditions.
Station :
Date : Signature of the applicant
Note : The Guardian may execute the above declaration, only if both the parents are not alive.
DETAILS OF ORIGINALS SURRENDERED AT THE TIME OF ADMISSION
[Link]. For I year B.E. / [Link]. Admission [Link]. For Lateral Entry Students
1. SSLC Mark Sheet 1. SSLC/HSC Mark Sheet
2. HSC Mark Sheet 2. V Sem Mark Sheet
3. Transfer Certificate 3. VI Sem Mark Sheet
4. Community Certificate 4. Consolidated Mark Sheet
5. Allotment Order 5. Provisional / Diploma Certificate
6. Rank Certificate 6. Transfer Certificate
7. First Graduate Certificate (GQ) 7. Community Certificate
8. FG Joint Declaration Form (GQ) 8. Allotment Order (GQ)
9. Passport Size Colour Photo 2 Nos 9. First Graduate Certificate (GQ)
10. Income Certificate 10. FG Joint Declaration Form (GQ)
11. Passport Size Colour Photo 2 Nos
12. Income Certificate
[Link]. For MCA / MBA Students [Link]. For ME Students
1. Allotment Order 1. Allotment Order
2. Provisional / Degree Certificate 2. Provisional / Degree Certificate
3. Consolidated Mark Sheet 3. Consolidated Mark Sheet
4. UG Mark Sheets (I to Final Sem) 4. UG Mark Sheets (I to Final Sem)
5. HSC Mark Sheet 5. HSC Mark Sheet
6. SSLC Mark Sheet 6. SSLC Mark Sheet
7. Transfer Certificate 7. Transfer Certificate
8. Community Certificate 8. Community Certificate
9. Entrance Mark sheet 9. Entrance Mark sheet
10. Entrance Hall Ticket 10. Entrance Hall Ticket
11. Passport Size Colour Photo 2 Nos 11. Passport Size Colour Photo 2 Nos
12. Income Certificate 12. Income Certificate
Signature of the Parent Verified Signature of the Student
Date : Admission Officer