FC (Special Education-Distance Education) Application Form 2018-19

Study Centre & Programme Details

PROGRAMME SESSION
BATCH Last Date
ELIGIBLITY MEDIUM
STUDY CENTRE ADDRESS

Personal Details

FIRST NAME LAST NAME
FATHER'S NAME MOTHER'S NAME
GENDER CATEGORY 
DOB  SUB CATEGORY
NATIONALITY  
RELIGION MARITAL STATUS

Address

Correspondance
Permanent
Copy to Permanent Address

Other Details

Phone Number(With STD Code) Mobile Number
Email Id Fax No.
Photo Id Photo ID No.

Educational Qualification

Examination
Institute/University
Year of Passing
% of Marks
Division

Enclosures

ALL MARKSHEET[10th/12th/GRADUATION]
CASTE CERTIFICATE
HANDICAPTED CERTIFICATE
2 PASSPORT SIZE PHOTO
TEACHING EXPERIENCE CERTIFICATE

Fee Details

FORM + PROGRRAME FEE Late Fee PORTAL FEE TOTAL FEE
150+2000 = 2150
0
50
2200
DECLARATION
I HEREBY DECLARE THAT I HAVE READ AND UNDERSTOOD THE CONDITION OF ELIGIBILITY FOR THE PROGRAMME FOR WHICH I SEEK ADMISSION.I FULFILL THE MINIMUM ELIGIBILITY CRITERIA AND HAVE PROVIDED NECESSARY INFORMATION IN THIS REGARD.IN THE EVENT OF ANY INFORMATION BEING FOUND INCORRECT OR MISLEADING,MY CANDIDATURE SHALL BE LIABLE TO CANCELLATION BY THE UNIVERSITY AT ANY TIME AND I SHALL NOT BE ENTITLED TO REFUND OF ANY FEE PAID BY ME TO THE UNIVERSITY