TEMPORARY APPLICATION FORM FOR ADMISSION TO
ONE SITTING / DISTANCE / REGULAR EDUCATION PROGRAMME
Use Block Capital letters to fill up
Course Applied for :
Course From :
Distance / Regular :
Name of the candidate :
Father’s Name :
Mother’s Name :
Date of Birth (in figures) :
Mailing Address :
Pincode :
Medium of Study :
Gender :
Phone No. :
Marital Status :
Email ID :
Details of Examinations Passed (Enclose all the copies of Certificates & Mark sheets)
Sl.No. Exam Passed Board / University Roll No Year % of Mark
Place : Date : Signature