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.Father’s
/Husbands Name:
4.
Mother’s Name
5.Applicants
Complete Correspondance 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.
D.O.B.
Please
tick( ) 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.
Applicant’s Complete Permanent Address
22.City
23.Pin Code
24.State
25.STD Code
26.Phone No.
:
27.
Educational Qualification :
| Examination |
Stream |
Board/University |
Year of passing |
% of marks |
| 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 .
|
