Application for admission to Post – Graduate / PG Diploma Courses during 2010-2011
1. Course Applying for
Application No*: PG/2010-11/9812335
2. Name (in block letters)
(as in the SSLC Mark Sheet)		 2.a. Photo
3.a. Name of Father / Guardian and Occupation
    b. Name of Mother and Occupation
4. Sex Male   Female 5.Date of Birth  
6. Select Native State 7.Select Community
8. Number of Members in the Family
9. Details of Registration Fee DD Date
 		 Bank Name
 DD / Challan No
10. Annual Income of the Family
11. Address for Communication
Phone Number
Mobile Number
E-mail ID
12.Permanent Address
Your Permanent Address is same as Communication Address
Phone Number
Mobile Number
E-mail ID
13. Details of Qualifying Examination (U.G Level)  Passed   Yet to Pass
   a. Degree & branch of study
   b. Name of the College
   c. Name of the University
   d. Register Number
   e. Month & Year of Passing
Subject Marks obtained upto
V sem. / II year		 Max. Marks Percentage of Marks
PartI
PartII
Part III (excluding FC, NSS etc.)
Major / Main
Ancillary / Allied I
Ancillary / Allied II
14. Details of other PG courses applied for in this University 15.Extra curricular activities
Note : All Fields are Mandatory
* Application no is temporary