App.
Online:2025-'26
SEMESTER PATTERN
ANNAMALAI UNIVERSITY APPLICATION NO.
CENTRE FOR DISTANCE AND ONLINE EDUCATION
Annamalainagar - 608 002. 135907
Application for Admission to
FOR OFFICE USE ONLY
Diploma / Certificate /Grade Certificate ENROLMENT NO.
Programme in Music and Dance
2025 - 2026
SPOT CODE
(REFER PROSPECTUS FOR DETAILS) (Make a tick-mark () in square q wherever applicable)
A RECENT
PASSPORT SIZE
1. Programme PHOTOGRAPH
Code & Name SHOULD BE PASTED
AND SIGNED BY
2. Medium: English q Tamil q THE APPLICANT
3. Name in CAPITAL LETTERS with Initials (in English)
4. Father's Name / Spouse Name / Guardian Name
5. ADDRESS IN CAPITAL LETTERS (to which communication and self learning study materials are to be sent)
PIN
Dist.
Phone No.
State (with STD Code)
6.E-mail ID Mobile No. :
7. Date of Birth Date Month Year
(as entered in the School Leaving Certificate) Age
8. Aadhaar Number:
9. ABC ID (See Prospectus)
10. DEB ID
11. Sex: Male q Female q Transgender q 12. Nationality:
13. Religion: Hindu q Muslim q Christian q Others (specify)
14. Community: ST SC SCA MBC DNC OBC BC BCM OC
15. Differently Abled: YES q NO q Visually challenged q Others Percentage
(specify)
16. Qualifying Examination Passed:
Name of the Duration of Name of the Reg. No. Percentage of Class
Marks/Grade
Examination Programme University/Board and Year point Obtained
Main :
Ancillary :
Application Fee ` 118/- (including GST)
17. Pattern of passing 11+2+2 q 11+1+3 q 10+2+3 q 10+2+4 q
the Degree Examination: (Direct OUS UG / PG Degree are Not Eligible)
[Link] Examination Passed (Grade Certificate Programmes):
Name of the Duration of Name of the School
Examination Programme / University / Board PASS / FAIL
19. Occupation /Designation Government q Non-Government q Others q
20. Are you presently undergoing any
other programme in any institution Yes q No q
(including CDOE)? If yes, give details :
DECLARATION
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 study materials, PCPs, response sheets, examinations, remittance of fees, etc., only the Courts and Tribunals having
jurisdiction over Annamalainagar (Chidambaram), Cuddalore District, Tamil Nadu 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 Centre for Distance and Online Education or the Controller of Examinations, Annamalai University.
Place:
Date: Signature of the Applicant
Enclosures:(1) Degree Certificate / Course completion certificate /Provisional certificate q (5) Photostat Copy of Community Certificate q
(except OC)
(2) Photostat Copy of Mark List or Consolidated Mark List q (6) Data Sheet duly filled in q
(3) Photostat Copy of Transfer or Migration Certificate q (7) Aadhaar Card q
(4) Identity Card duly filled in q
(Do not enclose original certificates)
FOR OFFICE USE ONLY ELIGIBLE q NOT ELIGIBLE q
CERTIFICATES VERIFIED REMITTANCE PARTICULARS
1) Degree/Provisional/Course completion q Name of the Bank :
2) Transfer OR Migration/Any Certificate for Age proof q Online/PoS Transaction No. :
3) Marksheets (10th/12th Standard) q Amount :
4) 8th Standard Transfer Certificate q Date : Selected
5) 10th Standard Transfer Certificate q Rejected
6) Aadhaar card q
Provisionally selected for admission.
Official in-Charge Section Head
Whether Original Certificates/Marksheets Whether study materials received? Yes q No q
received after verification? Yes q No q If yes, Complete set q Incomplete set q
Signature of the Candidate
Admission Confirmed
___________________________is hereby provisionally selected for the ______________________
Seat Assistant Section Head Co-ordinator DIRECTOR
DATA SHEET Application Number
(FILL UP THE DETAILS IN CAPITAL LETTERS)
2025-2026 135907
ENROLMENT No. [ For Office use only ]
Affix recent
Passport size
PROGRAMME CODE Photograph
SPOT CODE
without
NAME OF THE PROGRAMME
attestation / stamped seal
for scanning
MEDIUM English Tamil
I Year II Year III Year
OPTIONAL SUBJECTS (if any)
NAME OF THE APPLICANT WITH INITIALS
NAME OF THE FATHER / SPOUSE / GUARDIAN
ADDRESS
PIN
DATE OF BIRTH D D M M Y Y Y Y
AADHAAR NO.
ABC ID
DEB ID
QUALIFICATION
DIFFERENTLY ABLED YES NO
NATIONALITY
RELIGION
COMMUNITY
Contact Details:
Phone:
Mobile:
E-mail:
SIGNATURE OF THE APPLICANT
135907
To be filled in by the candidate in his/her own
handwriting
Name:
ANNAMALAI UNIVERSITY Address:
CENTRE FOR DISTANCE AND ONLINE EDUCATION
Annamalainagar - 608 002.
IDENTITY CARD
PINCODE:
Date of Birth :
Appln. No. :
Programme :
Affix recently Medium : Tamil / English
taken passport
size photo Optional :
ACADEMIC YEAR : 2025-2026
For Office Use Only
Enrolment No.
.........................
Signature of the Candidate DIRECTOR