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Admission Form For M.A Part-L 2017-18

This document is an application form for admission to the Post Graduate Degree Course at the University of Kalyani's Directorate of Open & Distance Learning. It includes sections for personal information, payment details, academic qualifications, and a declaration of eligibility and adherence to university regulations. Applicants must provide supporting documents and ensure the application is complete to avoid rejection.

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Satirtha Subham
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15 views2 pages

Admission Form For M.A Part-L 2017-18

This document is an application form for admission to the Post Graduate Degree Course at the University of Kalyani's Directorate of Open & Distance Learning. It includes sections for personal information, payment details, academic qualifications, and a declaration of eligibility and adherence to university regulations. Applicants must provide supporting documents and ensure the application is complete to avoid rejection.

Uploaded by

Satirtha Subham
Copyright
© © All Rights Reserved
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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Name of the Study Centre :

Date of Admission :

University of Kalyani
DIRECTORATE OF OPEN & DISTANCE LEARNING
Kalyani, Nadia: 741235, W.B.
APPLICATION FORM …………………………
Checked by
Course: ……………………. Subject: ……………………………… Session: ………………………………..

To Payment Details (Through State Bank Collect)


a) A/c Name- DODL University of Kalyani A/c SBC
The Director
Directorate of Open & Distance Learning b) SB Collect Reference No. : ……………………………………….
University of Kalyani
c) Amount Rs. :……………………………………….
Kalyani, Nadia,
PIN: 741235, W.B. d) Date of Payment : ……………………………………..

Sir,
I beg to apply for admission to the Post Graduate Degree Course through Open &
Affix here a recent
Distance Learning mode as mentioned above for your kind consideration. Passport size color
Photograph duly
………………………………….. ……………………………………………………….. signed by the
Candidate
Date Signature of the candidate

Personal informations:
1. Name of the applicant (in block letters) : ………………………………………………………………………………
2. Father’s/Mother’s Name (in block letters) : ………………………………………………………………………………
3. Address (in block letters mentioning the pin code)
(a) Permanent : ………………………………………………………………………………
………………………………………………………………………………

(b) Mailing (for communication) : ………………………………………………………………………………

………………………………………………………………………………
(c) Telephone /Mobile No. (if any) : ………………………………………………………………………………
4. Date of Birth (Encl. supporting document) : ………………………………………………………………………………
5. (a) Are you employed anywhere ? : ………………………………………………………………………………
(b) If so, give details including the name and : ………………………………………………………………………………
address of the employer
6. Institution / college last attended : ………………………………………………………………………………
7. Name of the University last attended : ………………………………………………………………………………
8. Result of the last examination passed : ………………………………………………………………………………
Mentioning class / division and the year ………………………………………………………………………………

9. Rural/Urban (give tick mark in the appropriate box) : R U


10. Sex (give tick mark in the appropriate box) : Male Female Transgender
11. Marital Status : Married Un-married
12. a. Whether belongs to Minority Community : Yes No
b. if yes, please specify :

13. Do you belong to SC/ST/ OBC : SC ST OBC-A OBC-B


(If so, attach supporting document)

14. Whether belong to BPL Category? : Yes No

15. Are you physically challenged? : Yes No

16. Academic qualifications


(Attach self attested photocopies of supporting documents)

Exam. Year of Marks Division Subject(s)


Name of the Board / University
Passed Passing obtained Out of % / Class Studied

Declaration:
After going through carefully and comprehending the contents of the rules & regulations, I solemnly declare that I
shall abide by all the provisions laid down therein.

If it is found at any stage during the course of my study that I did not possess the required eligibility for
admission, or if I do anything in violation of the University Act, Statutes, Ordinances, Regulations or other rules
framed through administrative power, I shall be liable to any disciplinary action as the University authority deems
fit .In the event of cancellation of admission, I shall not be entitled to refund of any fee paid by me.

I also declare that all Information furnished above is correct and true.

Date: ……………………………… …………………………………………………….


Signature of the candidate
 Students coming from other University/Institution for admission into DODL Courses shall be required to submit
migration certificate from the Institution last attended.
 Incomplete application in any respect or application not bearing the requisite application fee will summarily be rejected.

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