(Affiliated to Mangalore University)
Application for Admission to M.S.W Course
1. Name of the candidate in full (block letters) to be entered as found in the certificate of the qualifying examination. *
2. Father’s Name
3. Mother’s Name
4. Name of the guardian and relationship (if father is not alive)
5. Permanent address of father or guardian
6. a) Telephone Number *
b) Email Address *
7. Religion and Caste
8. Whether you belong to Scheduled Caste / Scheduled Tribe / Backward Class. State sect if you belong to Any one of these categories.
9. Occupation of Father / Guardian
10. Annual Income of Father / Guardian
11. a] Date of Birth (In Christian era)
b] Place of Birth (Here enter Place, Taluk & District)
c] State of domicile
d] Mother tongue
e] Languages which you can read, write and speak
12. Are You –
a] A citizen of Indian Union? If not mention nationality
b] Native of Karnataka State? If not, to which state do you belong?
c] Have you applied to the Mangalore University for Eligibility Certificate? Yes No
13. Academic Particulars
Exam Passed Name and Address of the School / College Name of the Board / University No. of attempts for passing Percentage and class in which passed Year of Passing
a.) SSLC / Matric

b.) PUC / (10+2) or Equivalent Examination

c.) Degree Examination

14.Total marks obtained and percentage of marks secured in all subjects upto two decimal points in (10+2) / Equivalent Examination.

Marks out of
Aggregate Percentage
15.Professional Experience if any
16. Hobbies
17. Games / Sports
18. List any outstanding performance medals / certificates received.

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