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Pondicherry University Distance Education Application Form

This document is an application form for admission to the Directorate of Distance Education at Pondicherry University. [1] It requests basic information about the applicant such as name, address, date of birth, educational qualifications. [2] The form also asks for details of the course being applied for, preferred study center, and fee payment details. [3] The applicant is required to declare that all information provided is correct and acknowledge the university's right to reverse admission decisions based on incorrect information.

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Tinku Sri
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191 views2 pages

Pondicherry University Distance Education Application Form

This document is an application form for admission to the Directorate of Distance Education at Pondicherry University. [1] It requests basic information about the applicant such as name, address, date of birth, educational qualifications. [2] The form also asks for details of the course being applied for, preferred study center, and fee payment details. [3] The applicant is required to declare that all information provided is correct and acknowledge the university's right to reverse admission decisions based on incorrect information.

Uploaded by

Tinku Sri
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Appl.

No:A

PONDICHERRY
(A Central University)

UNIVERSITY

DIRECTORATE OF DISTANCE EDUCATION


FORM OF APPLICATION FOR ADMISSION
Admitted Yes . No.. (For Office use) Enrolment Number Passport size Photograph
(To be attested by Gazetted Officer)

Signature of the Admission Officer 1. Name of the applicant (in BLOCK LETTERS)
(As per Academic Records)

Original Certificates verified by

2. Address to which communication is to be sent: (in BLOCK LETTERS)


line 1

line 2

line 3

line 4

Pin code

Phone/Mobile: STD Code

3. Students E-mail ID :__________________________________________________________________ 4. Date of Birth:Day: 6. Place of Birth: Month: Year: 5.Sex:M-Male/F-Female:

R-Rural / U-Urban 7. Social Status :

(SC-01, ST-02, OBC-03, OC-04)

8. Name of the course applied______________________________Code If MBA(General) please ( ) indicate stream A B C

9. PCP Centre chosen ___________________________________ Code

12.

PONDICHERRY UNIVERSITY (A Central University)


DIRECTORATE OF DISTANCE EDUCATION IDENTITY CARD

Address:___________________________________ ___________________________________ ___________________________________ Enrol No.

Affix stamp size photo only

Name: Course:

Signature of the Candidate

DIRECTOR

10. Fee Concession Category:


(Non-teaching employees-01, Defence personnel-02, Physically Challenged-03, Widows-04, Deserted Women05, Prisoners-06, Trans-genders -07)

11. Fee Particulars Bank


for mode of payment of fee, pl. refer information brochure

DD/Chalan No.

Date
:

Amount (Rs.)

12. If employed, indicate designation along with the office address

13. Details of Educational Qualification (Please provide full details of your educational qualifications)
Examination passed Name of the Course Name of the Institution / College / University Year of Passing Subjects Class/Grade / Percentage

HSc/Equivalent Degree Post Graduation Others(Specify)

Declaration I declare that all the information furnished in this application form is correct and complete. I acknowledge that the Pondicherry University reserves the right to reverse at a later date any decision regarding admission made on the basis of incorrect or incomplete information provided by me. I declare further that I had read & understood all contents of this application form & Information Brochure and that I am bound by all their contents for all purposes. Date: Signature of the Candidate

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