Chennai School of Ship Management

Application Form

Please fill up all the fields. If any of these information, i.e., Father’s & Mother’s email id,/Fax No., and Extra curricular activities, are not available, write NA.

	Photo (Download your recently taken passport size photograph and paste it here. To be filled must)	:



	Full Name of the Candidate (Capital Letters)	:

	Details of Demand Draft :

	Name of the Bank	:
	Branch & Code	:
	DD No.	:
	Date	:
	In favour of	:

PERSONAL DETAILS

Date of Birth

Gender

Male Female

Father's Name

Mother's Name

Physical Identification Mark (any one)

Marital Status

Married Unmarried

Permanent Address

PIN Code

City

State

Communication Address

PIN Code

City

State

Enter a valid email id; The date of interview and any other instructions regarding admission will be sent through your email id only and it will enable you to log in this page, later on to submit your marks and any other incomplete data only twice.

E-mail

(This will be your username)

Password

Confirm password

Fax No.

(if information not available; mark as NA)

Mother tongue

Residence Phone Number with STD code

STD - No.

Mobile No.

Nearest Police Station (This will be use for your Passport, CDC and other purposes).

Nearest Railway Station

Nearest Air Port

Place of Birth

Caste

BC MBC SC ST OC

Nationality

Religion

Extra-curricular activities :

Class	Sport/Activity	Level of participation	Position

Others

Information not available

PHYSICAL FITNESS

Blood Group

Eye sight power (Both the eyes)

Height in cm

Weight in Kgs

If undergoing any treatment, Mention

Allergies to any type of Food/ Medicine, Mention

ABOUT FAMILY

	Father’s	Mother’s
Occupation		(if information not available; mark as NA)
Mobile Number		(if information not available; mark as NA)
Email ID	(if information not available; mark as NA)	(if information not available; mark as NA)
Communication Address
Annual Income		(if information not available; mark as NA)
Family Members
Sister/s	(if information not available; mark as NA)
Brother/s	(if information not available; mark as NA)

ACADEMIC RECORD

	Class X	Class XII
Name of the School
Examination Board
Name of the State
Year of Passing:
Aggregate Marks	% (for all subjects)
English	%
Medium of Instruction
Examination Registration Number

Results (After publishing the 12th results the same to be submitted, entering the marks to go to the login page)

Awaiting Published

Year of Passing					:
Marks Details

Subject		Max Marks		Pass Marks		Secured Marks (Theory+Practicals)	Percentage

Physics	:						%

Chemistry	:						%

Maths	:						%

Total aggregate in PCM		:	%
Aggregate Marks		:	%			English	: %

How are you planning to spend your holidays after Completing class XII exam or before you join college?
(Write a paragraph about 300 words)

What are you Hobbies?

What are your Strengths?

What are you Weaknesses?

How did you come to know about CSSM?

Newspaper

Website Friends Alumni School

Name of the School	:
Advertisement	:	Seen on the Notice board
Place	:
State	:

Others

How do you propose to arrange the expenses of this program?

Own Resources Thro’ Relatives Bank Loan Other Sources

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