SATHYABAMAUNIVERSITY
(Established under Section 3 of UGC Act 1956)
( A CHRISTIAN MINORITY INSTITUTION )
Jeppiaar Nagar, Rajiv Gandhi Road, Chennai – 600 119.
APPLICATION FORM FOR
COMMON ENTRANCE EXAMINATION - 2009
FOR B.D.S. DEGREE COURSE
Affix Passport size colour Photograph hereNAME OF THE CANDIDATE : ......
(IN BLOCK LETTERS)
SATHYABAMAUNIVERSITY
(Established under Section 3 of UGC Act 1956)
( A CHRISTIAN MINORITY INSTITUTION )
Jeppiaar Nagar, Rajiv Gandhi Road, Chennai – 600 119.
BDS Entrance Examination 2009-2010.
APPLICATION FORM
1. Name (in BLOCK LETTERS as given: ______
in X Std Certificate
2. Father’s / Guardian’s Name: ______
3. Mother’s name: ______
4. Gender (tick (√) the appropriate box): Male Female
5. Nationality (if foreign origin, indicate :
name of the country, Attach Proof
Like Passport / Visa)
6. Date of Birth (Attach photocopy of the :
X Std marks sheet for age proof) Date Month Year
7. Religion: ______
8. Social Status / Community : OC / BC / MBC / SC / ST
9. Marital Status: ______
10. Mother Tongue: ______
11. Parent’s Occupation: Father : ______12. Parent’s Annual Income in Rs:______
Mother : ______Mother : ______
13. Postal Address for Communication14. Permanent Address
(IN BLOCK LETTERS): (IN BLOCK LETTERS):
______
______
______
State : ______Country: ______State : ______Country: ______
Pin Code: ______Pin Code: ______
Contact Tel. No: ______Contact Tel. No: ______
Email: ______Email: ______
15. Qualifying Examination Details:
Name of the Board / University / Exam Passed / Register Number / Month & Year of Passing(i) Medium of Instruction in HSC :
(ii) Marks obtained in the Qualifying Examination :
(iii) Higher Secondary (Academic Stream / Equivalent):
Subjects / Marks Obtained / Maximum Marks / % of (i) (ii) & (iii) put togetheri) Physics
ii) Chemistry
iii) Biology
or
iv) Botany and
Zoology
16. Sports Represented: District Level State Level National level None
17. Hostel Accommodation: Required / Not Required
18. Details of Application fees paid :
i) Cost of Application: Rs. 500/-
ii) DD Should be drawn in favour of : Sathyabama University Payable at Chennai.
iii) Mode of Payment: Bank Challan / Demand Draft No.
SATHYABAMAUNIVERSITY
(Established under Section 3 of UGC Act 1956)
( A CHRISTIAN MINORITY INSTITUTION )
Jeppiaar Nagar, Rajiv Gandhi Road, Chennai – 600 119.
BDS Entrance Examination 2009
HALL TICKET
(To be filled by office)
Affix Passport size colour Photograph hereRegister Number:
Examination Venue: ______
______
______
Date of Examination: ______
Time of Examination: ______
(To be filled by the Candidate along with the application form)
Name of the Candidate: ______
(IN BLOCK LETTERS)
Postal Address: ______
(IN BLOCK LETTERS)
______
______
State: ______Country: ______
Pin Code: ______
Telephone NO: With STD Code: ______Mobile No: ______
Email ID: ______
Signature of Candidate Signature of Issuing Authority
SATHYABAMAUNIVERSITY
(Established under Section 3 of UGC Act 1956)
( A CHRISTIAN MINORITY INSTITUTION )
Jeppiaar Nagar, Rajiv Gandhi Road, Chennai – 600 119.
ADMISSION TO B.D.S. DEGREE COURSE
Name of the Degree Course / Duration / Eligibility Marks / Total No. of Sanctioned SeatsB.D.S. / 5 Years with integrated internship / As per DCI norms / 100
1. ELIGIBILITY FOR ADMISSION TO B.D.S. DEGREE COURSE:
A candidate should possess the qualification prescribed by the Dental Council of India, at the time of joining the course concerned.
Candidates should have passed H.S.C. (+2) (Academic Stream 10+2 curriculum of any State Board / CBSE / ISC)examination/equivalent examination and secured not less than 50% of marks (in case of SC/ST 40%) in the aggregate, in Physics, Chemistry & Biology or Botany & Zoology and a pass in English in the qualifying examination
Courses of StudyGroup of Subjects Specified
B.D.S.English, Physics, Chemistry, Biology or Botany & Zoology
Note:
(i) Candidates belonging to any State/Union Territory are eligible.
(ii) Candidates who are appearing for the H.S.C. (+2) equivalent Examination,
Should submit a photocopy of the H.S.C.(+2) mark sheet.
2. AGE LIMIT:
Candidates should have completed 17 years of age as on 31st December, 2009. Date of birth given in the HSC/ISC or its equivalent Mark Sheet or in the Birth Certificate or Passport shall be taken for computing the age of the candidates.
3.INSTRUCTIONS TO FILL THE APPLICATION FORM
(a) Application form should be filled in carefully and legibly by the candidate in his/her own handwriting.
(b) Incomplete Applications will be summarily rejected.
(c)Candidates should enclose only photocopies of the relevant certificates along with the Application form.
(d) Candidates should affix Recently taken passport size Colour photographs in the space provided in the Application Form. The candidates should sign on the photographs affixed on the Hall Ticket Forms.
4.MODE OF SELECTION:
(a)Selection will be made on the basis of marks secured by the candidates in the Common Entrance Examination conducted by our University. Intimation letter will be sent to the candidates provisionally selected for admission, on merit basis.
(b) In case of candidates securing the same marks in the Entrance Examination, selection will be made based on their academic performance in the qualifying examination prescribed for admission.
5.IMPORTANT NOTE:
(a) All admissions are subject to fulfillment ofthe eligibility criteria prescribedby the Dental Council of India.
(b)The Candidates Admission will be cancelled without any notice, if the candidate has provided false information or forged the Certificates.
(c) The University reserves the right to amend the rules relating to Admission, Examination, Fees structure, Refunds, etc., from time to time
6.SUBMISSION OF CERTIFICATES:
Verification of original certificates will be made at the time of admission. Candidates selected for admission will have to Submit all required original certificates with the University office.
7. CHANGE OF NAME IN OFFICIAL RECORDS:
The name of the candidates will be registered in the records of the University as given in their H.S.C. Mark Sheet/Transfer Certificate only. Any request for change of Nameshould be submitted along with a coy of notification of the change mode in the Government Gazette, to the Registrar of the University.
8. MEDICAL EXAMINATION:
The candidates provisionally selected for admission will have to undergo a medical examination Conducted by our university Medical Officer. Those who are found to be medically fit to undergothis course.
9.CHECK LIST OF ENCLOSURES ALONG WITH THE APPLICATION FORM:-
i.Photocopy of the H.S.C.: (+2) equivalent Hall Ticket if appeared for H.S.C. equivalent Examination.
ii. Photocopy of Mark sheet(s) issued by (State Board/CBSE/ISC or any other equivalent authority if already passed +2 Examinations:
iii. Photocopy of Birth Certificate for proof of age if date of birth not given in the HSC Mark Sheet or Transfer Certificate:
iv. Photocopy of Transfer Certificate/Migration Certificate.
v. Photocopy of Conduct Certificate issued by the Head of the Institution last studied.