ANNA UNIVERSITY, CHENNAI-600 025
July 2011 – May 2012 session
CERTIFICATE COURSE IN FOREIGN LANGUAGES (OPTIONAL)
for higher semester students of CEG/ACTECH/MIT/SAP Campus
Application Form
1. Name of the student (Block Letters):
2. Roll No.
3. Programme (UG/PG)
4. Semester
5. Campus
6. Branch and Batch
:
: BE/BTech/ME/MTech/MBA/MSc/PhD
:
: CEG/ ACTech/ MIT/ SAP
:
7. Marks obtained in English in
the +2 examination
(enclose attested Xerox copy)
:
8. Second language at +2
:
9. Choice of Language for study
: French / German / Japanese
Please mention the chosen course in order of priority
1st Choice
:
nd
2 Choice
:
3rd Choice
:
10. Hostel address
:
(for those who stay in hostel)
11. Father’s name & address
12. Contact No. Telephone & Mobile
Email
Date:
:
:
:
Signature of the candidate
NOTE: Students of CEG, ACTech and SAP should submit this form at the Department of
English, CEG Campus (044-22358726) and Students of MIT Campus should submit the form at
the Department of English, MIT Campus (044-22516158)