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    Eqdrlokè K Ihbe : JKF"V Lalñrlalfkkue (Ekfurfo'Ofo - Ky %)

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    Abhishek Chaturvedi
    This document is an application form for admission to the Prak-Sastri programme of the Institute of Distance Education for the 2013-2014 academic year. The form requests information such as the applicant's name, father/husband's name, date of birth, gender, caste, occupation, address, payment details, educational qualifications, optional and compulsory subject preferences, and contact class attendance preferences. The applicant must declare that the information provided is true and agree to abide by the institute's rules. Once completed, the form will be reviewed by office staff who will note the admission status and subject preferences before issuing a receipt.

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    © All Rights Reserved
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    Eqdrlokè K Ihbe : JKF"V Lalñrlalfkkue (Ekfurfo'Ofo - Ky %)

    Uploaded by

    Abhishek Chaturvedi
    15 views2 pages
    This document is an application form for admission to the Prak-Sastri programme of the Institute of Distance Education for the 2013-2014 academic year. The form requests information such as the applicant's name, father/husband's name, date of birth, gender, caste, occupation, address, payment details, educational qualifications, optional and compulsory subject preferences, and contact class attendance preferences. The applicant must declare that the information provided is true and agree to abide by the institute's rules. Once completed, the form will be reviewed by office staff who will note the admission status and subject preferences before issuing a receipt.

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    514 Multiculturalism

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    This document is an application form for admission to the Prak-Sastri programme of the Institute of Distance Education for the 2013-2014 academic year. The form requests information such as the applicant's name, father/husband's name, date of birth, gender, caste, occupation, address, payment details, educational qualifications, optional and compulsory subject preferences, and contact class attendance preferences. The applicant must declare that the information provided is true and agree to abide by the institute's rules. Once completed, the form will be reviewed by office staff who will note the admission status and subject preferences before issuing a receipt.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    15 views2 pages

    Eqdrlokè K Ihbe : JKF"V Lalñrlalfkkue (Ekfurfo'Ofo - Ky %)

    Uploaded by

    Abhishek Chaturvedi
    This document is an application form for admission to the Prak-Sastri programme of the Institute of Distance Education for the 2013-2014 academic year. The form requests information such as the applicant's name, father/husband's name, date of birth, gender, caste, occupation, address, payment details, educational qualifications, optional and compulsory subject preferences, and contact class attendance preferences. The applicant must declare that the information provided is true and agree to abide by the institute's rules. Once completed, the form will be reviewed by office staff who will note the admission status and subject preferences before issuing a receipt.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    vkosnui=kØekÄï%µ2013@ Enrolment No.

    Alloted ___________________

    eqDrLokè;k;ihBe~
    (Institute of Distance Education)
    jkf"Vª;laLÑrlaLFkkue~ (ekfurfo'ofo|ky;%)
    56&57] bULVhV~;w'kuy ,fj;k] tudiqjh] uonsgyh&110 058
    izkd~&'kkL=kh ikBÔØe% (izFkeo"kZe~)
    vkosnui=ke~ (2013&2014)
    Application for admission into Prak-Sastri programme
    vo/krO;k% funsZ'kk%
    w vè;srk LogLrk{kjs.kSo vkosnui=ka iwj;sr~A The Application form should be filled by the Candidate
    in his/her own handwriting only. Paste your attested
    w viw.kZe~ vkosnui=ka fujkdfj";rsA Incomplete applications will be summarily rejected. passport size
    photogaph here
    w izo's k% fu;efo#¼ bfr Kkra psr~ izo's kkuUrjefi eqDrLokè;k;ihBa ;nk dnkfi izo's ka fujkdrq± izHkofrA The
    M.S.P reserves the right to cancel the admission of any candidate at any stage, if and where
    it is detected that the admission is aganist rules.
    __________________________________________________________
    1- (d) vè;srq% uke (nsoukx;kZe~)
    ([k) Name of the applicant (In English)
    (as entered in 10th Examination passed or__________________________________________________________
    equivalent Certificate)
    2. firq%@HkrqZ% uke
    Father's/Husband's Name (In English)
    __________________________________________________________
    3. ekrq% uke
    4. tUefrfFk% (DD/MM/YY) , vk;q%& ________ o"kZe~ (as on 01 July, 2013)
    5. fyÄõe~µ iq#"k% (M) efgyk (F) 6. tkfr%µ SC ST OBC PH Gen.
    7. O;olk;% (Occupation) ___________________________
    8. i=klÄïsr%@Address for correspondence ______________________________________________________
    (In capital letters only) ______________________________________________________
    Dis.________________________ State _______________________
    Pin ____________________
    PhoneNo. _______________________ Mob.___________________
    E-Mail __________________________________________________
    9. Mode of payment of Fees : DD No. ____________ Amount ___________(__________________________________)
    Date_______________Bank ___________________________________________________________________.

    10. 'kSf{kd;ksX;rk@Educational Qualification :


    mÙkh.kZijh{kkuke@ fo"k;k% ijh{kdlaLFkk;k% uke mÙkh.kZrko"kZe~ Js.kh izkIrkÄïk% izfr'krkÄïk%
    Name of the Subject Name of the Year of passing Class Marks Percentage
    Examination Passed Board of Exam. Obtained

    Ñ-i`-i-----
    :2:

    11. vfuok;Zfo"k;k% (Compulsary Subjects) µ


    'kkL=kh;fo"k;kSµ 1- O;kdj.ke~ [Vyakarana (100 vÄïk%)] 2- lkfgR;e~ [Sahitya (100 vÄïk%)]
    vk/qfudfo"k;kSµ 1- vkÄõye~ [English (100 vÄïk%)] 2- fgUnh [Hindi (100 vÄïk%)]
    12. vk/qfud% ,sfPNdfo"k;% [Optional Modern Subjects (100 vÄïk%)]µ (,da fpuksrq √ )
    bfrgkl% (History) ] vFkZ'kkL=ke~ (Economics) ] jktuhfrfoKkue~ (Poltical Science)
    13. 'kkL=kh;% ,sfPNdfo"k;% [ Optional-Sastriya Subjects (100 vÄïk%)]µ (,da fpuksrq √ )
    O;kdj.ke~ (Vyakarana) ] lkfgR;e~ (Sahityam) , iQfyrT;kSfr"ke~ (Phalit Jyotisham)
    14. lEidZd{kkfnfufeÙke~ e;k vfHkfyf"kra Lokè;k;dsUæLFkkue~µ __________________________________________________
    (I wish to attend counselling contact classes at the Svadhyaya Kendra situated at.)
    (v/ksfu£n‘Lokè;k;dsUæsH;% ,dL; uke fy[krqA Select any one of the Swadhyaya Kendras mentioned below.)
    1.Allahabad 2. Puri 3. Jammu 4. Guruvayoor/Pavaratty 5. Jaipur
    6. Lucknow 7. Sringeri 8. Balahar (H.P.) 9. Bhopal 10. Mumbai 11. Delhi

    * v/ks fu£n‘kuka izek.ki=kk.kka LolR;kfirk izfrÑfr% izLrksO;kA ;r~ u vUosfr rr~ R;DrO;e~A
    w n'ked{kksÙkh.kZrkizek.ki=ke~ (10th Exam. Pass-Certificate ) w n'ked{kk;k% vÄïi=ke~ (10th Exam. Pass- Marksheet)
    w tkfrizek.ki=ke~ (Caste Certificate )@fodykÄõizek.ki=ke~ w lsrqikBÔØeksÙkh.kZrkizek.ki=ke~ (Bridge Course Exam.
    Pass-Certificate )

    izfrKk@DECLARATION
    vfLeu~ vkosnui=ks e;k fu£n‘k% losZ¿fi fo"k;k%] le£irkfu rRleFkZdkfu i=kkf.k p loZFkk ;FkkFkZHkwrkuhfr izfrtkusA vuq'kklua lRizorZua
    p vf/ÑR; dfYirku~ eqDrLokè;k;ihBfu;eku~ ;Fkkonuqlfj";kehfr izfrtkusA ;fn ee izo`fÙk% vlehphuk] r£g eqDrLokè;k;ihBa U;k;ksfprfo/kua
    fo/krqe~ vgZfrA
    I solemnly declare that the entries made by me in this application form and the documents submitted in support of the
    information furnished by me are true in all respects. I shall abide by the rules of discipline and proper conduct which may be
    framed in this regard. The M.S.P. may take any action against me if the behaviour and conduct are against to the disciplinary code
    of the M.S.P.

    fnukÄï%µ vè;srq% iw.k± gLrk{kje~


    LFkkue~µ Signature of Learner

    dsoya dk;kZy;h;ksi;ksxk; (For office Use )

    vk/qfud% ,sfPNdfo"k;% (Optional Modern Subject) : _________________________________________

    'kkL=kh;% ,sfPNdfo"k;% (Optional-Sastriya Subject ) : _________________________________________

    izos‘qegZfr (May be admitted in) ____________________________

    Lokè;k;dsUæL; uke fyfid% Lokè;k;dsUæleUo;dL; gLrk{kje~


    e`nqeqæk Clerk Signature of Svadhyaya Kendra Co-ordinator
    Name of the Svadhyaya Kendra
    Seal
    &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
    # #
    Receipt
    vkosnui=kØekÄï%µ2013/ Enrolment No. Alloted ___________________
    vk/qfud% ,sfPNdfo"k;% (Optional Modern Subject ) : _________________________________________

    'kkL=kh;% ,sfPNdfo"k;% (Optional-Sastriya Subject) : _________________________________________

    izos‘qegZfr (May be admitted in) ____________________________

    Lokè;k;dsUæL; uke fyfid% Lokè;k;dsUæleUo;dL; gLrk{kje~


    e`nqeqæk Clerk Signature of Svadhyaya Kendra Co-ordinator
    Name of the Svadhyaya Kendra
    Seal

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