UNIVERSITY OF MYSORE

YUVARAJA'S COLLEGE, MYSORE

(Autonomous)
PART -B
APPLICATION FORM FOR ADMISSION TO
M.A. IN ENGLISH/M.Sc. IN CHEMISTRY (2 YEARS
SEMESTER COURSES) AND 5 YEAR INTEGRATED M.Sc. COURSE IN
MOLECULAR BIOLOGY (10 SEMESTERS)
Affix Passport Size
Photo
1. Name of the
(in Block Letters)
2. Name of the Parent/Guardian
3. (a) Place of Birth
(b) Date of Birth (as in the SSLC
Marks Card or its equivalent )
(c) Tel (with STD/ISD code)/Mobile No.
(d) E-mail :
4. Personal Particulars
5. Under which cagetory seat is claimed?
strikeout which ever is not applicable
(Certificate from the component authority shall
be attached, failing which the application will
not be considered under that category)
6. Name, Occupation and total
Annual Income of Parents/
Guardian (If parents not alive)
7.
(a) Postal Address :
(b) Permanent Address
8. Institution and University last attended
Father
Mother
Guardian
Village
Taluk
District
State
PIN
Day/Month/Year
Nationality
Caste
Sex
Mother tongue
GM/SC/ST/Cat-I/Cat-2A/Cat-2B/Cat-3A/Cat-3B/
Other University /NCC/Sports/Ex-serviceman/
Physically Challenged/Kannada Medium/
deputation/Foreigner/NRI/Kashmir Migrant/
Parsi
Name of Father/Guardian
Occupation
Annual income
Institution
Date of Admission
University
Date of completion of degree/PUC/+2
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9. (a) Degree /Qualifying examination passed
(b) Year of passing
(c) Percentage of Marks secured
(a)
(b)
(c)
10. (a) Total Marks of PCMB
(b) Marks scored in Biology (%)
(Only for M.Sc. Molecular Biology Students)
(a)
(b)
Have you pursued a Master Degree
Course in the University of Mysore or in
any recognised University in India in any
other subject during the previous years?
If so, furnish details.
University
Course Studied
Year
Total Marks
Marks Obtained
Percentage
Application fee receipt No.
Admission fee receipt No.
Category of the candidate
Date :
Date :
DD No. :
Marks obtained in the qualifying examination
Optional subject/
English (only for M.A.)
First Year Second Year Third Year
Total
I Sem II Sem III Sem IV Sem V Sem VI Sem
(1)
(2)
(3)
(4)
If repeater, give the details
DECLARATION
I submit this application seeking admission to 5 Year Integrated M.Sc.Molecular Biology Course (10
Semesters)/ M.Sc. in Chemistry/M.A. in English (four semesters). I declare that I have read the rules and
regulations in this regard.
I hereby solemnly and sincerely affirm that the statement/ made and information furnished in my
application form and also in the enclosures there to submitted by me are true. Should it however, be
found that any information furnished there in is untrue in material/particulars, I realize that I am liable to
criminal prosecution and the seat given to me shall be liable to be forfeited.
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(2)
Place :
Date : Signature of Applicant
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11.
(c) Average Marks of PCMB(%) (c)