APPLICATION
/REGISTRATION FORM FOR ENTRANCE/ADMISSION FOR SESSION
200
.-200
INSTRUCTIONS
: Use only
black ball pen to fill the form and write only in BLOCK
CAPITAL LETTERS.
1. Full Name of the Applicant:
3.Fathers
/Husbands Name:
4.
Mothers Name
5.Applicants
Complete Correspondence Address
6.City
7.
Pin Code
8.State
9.STD
Code
10.Phone
No
.
11.E-mail
12. DATE
[ ][
]
13. MONTH [
][ ]
14.YEAR [ ][ ][
][ ]
15.Nationality
16.
Date of Birth [in
words] ____________________________________________________
Please
tick R the
appropriate box
17.
Sex : Male[
] Female[
]
18.
Category : General[
] SC [
] ST [
] OBC[
]
19.
Course applied for :1-
.[
] 2-
[ ] 3-
[ ] 4-
[ ]
20.Any
other
21.
Applicants Complete Permanent Address
22.City
23.Pin Code
24.State
25.STD Code
26.Phone No.
:
27.
Educational Qualification :
| Examination |
Stream |
Name
of institution |
Board/University |
Year
of passing |
Total
marks scored |
%
of marks |
Subjects |
| High
School |
|
|
|
|
|
|
|
| Intermediate |
|
|
|
|
|
|
|
| Graduate |
|
|
|
|
|
|
|
| P.G.Diploma |
|
|
|
|
|
|
|
| Post
Graduate |
|
|
|
|
|
|
|
| Any
other |
|
|
|
|
|
|
|
28.
* Subjects :
(A)
(B)
29.
* P.G.Degree Marks
30.
Enclosures : High School
Marksheet (
) Intermediate
Marksheet (
)
Graduation Marksheet (
) Post Graduation Marksheet (
)
Transfer Certificate
(
) Character Certificate
( )
Any other
( )
31.
Fee deposited Rs
(Rs in
words)
through
Cash/DD No
.dt
.Receipt
No
.Dated
.
DECLARATION
I
hereby declare that all the particulars stated in this
application are true to the besat of my knowledge and
belief. In the event of suppression or distortion of any
fact like educational qualification, nationality, date of
birth etc. given in my application form, I understand that
my admission is liable for cancellation.
I
understand that fees once paid will not be refunded in any
case.
Date
:
Place :
Signature of the applicant
-_____________________________________________________________________
*
marked entries are to be filled only by the students
seeking admissionm in B.Ed or D.Ed.
|