DEMPO CHARITIES TRUST’S

DHEMPE COLLEGE OF ARTS & SCIENCE

PANAJI-GOA

Email: dhempe@rediffmail.com

Phone No. 0832-2462376, FAX : 0832-2462315

ADMISSION FORM

Note: All ‘*' marked fields are mandatory.

Student Details

Name should be exactly as shown in the H.S.S.C.E.statement of marks(For Foreign student,name as shown in the Passport)

Title

Applicant Full Name *

Mobile Number *

Father Name *

Mother Name *

D.O.B *

Age Age

Place of Birth *

Gender

Email *

State *

Country *

Permanent Address *

Aadhaar Card

Enter valid Aadhaar Number

Religion *

Nationality *

Category *

Student Photo *

Maximum file size 1MB , Format should be .png or .jpg or .jpeg

Passport Number

Enter valid Passport Number

Passport Issue Date

Passport Expiry Date

Visa Number

Enter valid Visa Number

Visa Issue Date

Visa Expiry Date

Marital Status *

Education Details

Institution Details

Name of Board *

Name of the Last School *

Institution Address *

No.Of Attempt *

Year of Passing *

Seat.No

Last Examination *

Marks Obatained

Total Mark *

Mark Obtained *

Percentage Percentage

Parent/Guardian Details

Parent/Guardian *

Parent/Guardian Name *

Landline Number

Mobile Number *

Mother Tongue

Additional Mobile Number

Student Bank Details

Bank A/C No

MICR Code:

IFSC Code:

Select Year, Course and Subjects

Select Year

Year *

Admission sought in Class *

Select Semester 1 Subjects

Courses *

Mandatory Course(CC) *

Core Group(DSC 1,2,3) *

AECC Subject *

Generic Elective *

Select Semester 2 Subjects

Mandatory Course(CC) *

Core Group(DSC 1,2,3) *

AECC Subject *

Generic Elective *

Select Semester 3 Subjects

Courses *

Mandatory Course(CC) *

Core Group(DSC 1,2,3) *

SEC-Skill Enhancement *

Generic Elective *

Select Semester 4 Subjects

Mandatory Course(CC) *

Core Group(DSC 1,2,3) *

SEC-Skill Enhancement *

Generic Elective *

Select Semester 5 Subjects

Courses *

Mandatory Course *

General Subjects *

Honours Subjects *

Select Semester 6 Subjects

Mandatory Course *

General Subjects *

Honours Subjects *

Your application has been submitted successfully.

Please take printout of this form & carry the same while visiting college for further admission process.

DEMPO CHARITIES TRUST’S

DHEMPE COLLEGE OF ARTS & SCIENCE

PANAJI-GOA

Email: dhempe@rediffmail.com

Phone No. 0832-2462376, FAX : 0832-2462315

ADMISSION FORM

Form.No.: {{aplform.AplnNum}}

Class : {{aplform.brNm}} {{aplform.semNm}} Roll No. _________________ Admission Receipt No. _________________

Form of Application for Admission 20 - 20

Date: {{todayDate|date:'dd-mm-yyyy'}}

To,
The Principal,
D.C.T’s Dhempe College of Arts & Science, Panaji, Goa.

Sir/Madam,
I apply for admission to the F.Y.S.Y.{{aplform.brNm}} – {{aplform.semNm}} in this institution.

I have read all the rules of the Institution, presently in force and hereby agree, to abide by them. I further agree to abide by all such other rules as may be made by the institution from time to time and will accept the decision of the matters as final. I promise to inform the Principal in writing as required under the rules in case I discontinue my studies or change the institution during the course of the year.

The necessary particulars are given below.
I endorse the application and the declaration made therein by my son/daughter/ward.

_____________________________________
(Signature of the Parent/Guardian with Date)

Your's faithfully,

_____________________________________
(Signature of the Applicant with Date)

Student Details:

Gender	Male Female Others
Name of student (This name should be exactly as shown in the H.S.S.C.E statement of marks)(For Foreign student, name as shown in the Passport)	{{aplform.Title}} {{aplform.FNa}}
Mobile Number	{{aplform.CnAdMob}}
Email	{{aplform.CnEmail}}
Father's name	{{aplform.FatNa}}
Mother's name	{{aplform.MotNa}}
Marital Status	{{aplform.mstus}}
Religion	{{aplform.Rlig}}
Permanent Address	{{aplform.PemAdd}}
Date of Birth : {{aplform.DOB}}	Age : {{aplform.age}}Years
Place of Birth : {{aplform.CnBpl}}	State : {{aplform.CnAdStat}}
Passport No : {{aplform.NRIPP}}	Passport Issue Date : {{aplform.PPDOI\|date:'dd-mm-yyyy'}}
Passport Issue Date : {{aplform.PPDOI\|date:'dd-mm-yyyy'}}	Visa No : {{aplform.VISAno}}
Visa Issue Date : {{aplform.VISADOI \|date:'dd-mm-yyyy'}}	Visa Expiry Date : {{aplform.VISAValid\|date:'dd-mm-yyyy'}}
Nationality : {{aplform.Natnl}}	Category : {{aplform.Cmnm}}
Aadhaar Card No. : {{aplform.NatID}}	Bank A/C No. : {{aplform.bkacno}}
MICR Code : {{aplform.micrcd}}	IFSC Code : {{aplform.ifsccd}}

Education Details:

Examination	Name of the school last attended	Name of Board	Month & Year of Passing	Seat.No	No.of Attempt	Mark Obtained/Total Mark	Percentage
{{aplform.QlfyEx}}	{{aplform.Inst}}	{{aplform.Univ}}	{{aplform.DateOfPass}}	{{aplform.RegNo}}	{{aplform.NoOfAtt}}	{{aplform.totmark}}/{{aplform.Ovraltot}}	{{aplform.percnt}}

Parent/Guardian Details:

a. Name of the {{aplform.parnt}}: {{aplform.FatNa}}

b. Landline Number: {{aplform.FatAdTel}}

Mobile Number : {{aplform.FatAdMob}}

c. Additional Mobile No.: {{aplform.MotAdMob}}

Mother Tongue: {{aplform.MothTng}}

a. Name of the {{aplform.parnt}}: {{parguarNm}}

b. Landline Number: {{aplform.MotAdTel}}

Mobile Number : {{aplform.FatAdMob}}

c. Additional Mobile No.: {{aplform.MotAdMob}}

Mother Tongue: {{aplform.MothTng}}

a. Name of the {{aplform.parnt}}: {{aplform.GrdnNa}}

b. Landline Number: {{aplform.GrdnAdTel}}

Mobile Number : {{aplform.FatAdMob}}

c. Additional Mobile No.: {{aplform.MotAdMob}}

Mother Tongue: {{aplform.MothTng}}

Subjects once chosen shall not be allowed to change:

1st Semester
Mandatory Course(CC) :
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DSC :
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AECC :
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Generic Elective :
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2nd Semester
Mandatory Course(CC) :
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DSC :
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AECC :
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Generic Elective :
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3rd Semester
Mandatory Course(CC) :
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DSC :
(i).{{semthree.crsNm}}
SEC :
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Generic Elective :
(i).{{semthree.elcNm}}

4th Semester
Mandatory Course(CC) :
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DSC :
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SEC :
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Generic Elective :
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5th Semester
Mandatory Course :
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General Subjects :
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Honours Subjects :
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6th Semester
Mandatory Course :
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General Subjects :
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Honours Subjects :
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