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Pondicherry University: Directorate of Distance Education

This document is an application form for admission to Pondicherry University's Directorate of Distance Education. It requests basic personal information from the applicant such as name, address, date of birth, gender, social status, course applying for, educational qualifications and contact details. The applicant is also asked to provide fee payment details and declare that the information provided is true. If admitted, spaces are provided for the admission officer's signature and verification of original certificates.

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Anonymous fFsGiy
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53 views2 pages

Pondicherry University: Directorate of Distance Education

This document is an application form for admission to Pondicherry University's Directorate of Distance Education. It requests basic personal information from the applicant such as name, address, date of birth, gender, social status, course applying for, educational qualifications and contact details. The applicant is also asked to provide fee payment details and declare that the information provided is true. If admitted, spaces are provided for the admission officer's signature and verification of original certificates.

Uploaded by

Anonymous fFsGiy
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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Admitted Yes . No..

(For Office use) Enrolment Number





Signature of the Admission Officer Original Certificates verified by
PONDICHERRY UNIVERSITY
(A Central University Accredited with A Grade by NAAC)
DIRECTORATE OF DISTANCE EDUCATION

FORM OF APPLICATION FOR ADMISSION







1. Name of the applicant
(in BLOCK LETTERS)
(As per Academic Records)
2. Name of Parent/ Guardian

3. Address to which communication is to be sent: (in BLOCK LETTERS)




Pin code


4. Students E-mail ID :__________________________________________________________________


5. Date of Birth: Day: Month: Year: 6.Sex: M-Male/F-Female:


7. Place of Birth: R-Rural / U-Urban 8. Social Status: (SC-01, ST-02, OBC-03, OC-04)


9. Name of the course applied________________________________________ Course Code:


10. PCP Centre chosen ________________________________________Centre Code:









Passport size
Photograph
Appl. No:







line 1

line 2

line 3


line 4
STD Code
Phone No.
Mobile No :



11. Fee Concession Category: (Proof to be attached)
(Non-teaching employees-01(Group B, C & D only), Defence personnel-02, Physically Challenged -03,
Widows-04, Deserted Women-05, Prisoners-06, Trans-genders -07)


12. Fee Particulars:-

DD/Chalan No. Date:


Amount (Rs.): Bank Name:



13. If employed, indicate designation :
with the office address :

14. Details of Educational Qualification
(Please provide full details of your educational qualifications)
Examination
passed

Name of
the
Subject
Name of the Institution /
College / University
Year of
Passing
Class/Grade /
Percentage
SSLC/10
th
Std

HSc/ Equivalent

Degree/
Equivalent

Post Graduation

Others(Specify)


Declaration

I declare that all the information furnished in this application form is correct and complete.
I acknowledge that the Pondicherry University reserves the right to reverse at a later date any decision
regarding admission made on the basis of incorrect or incomplete information provided by me.
I declare further that I had read & understood all contents of this application form &
Information Brochure and that I am bound by all their contents for all purposes.




Date: Signature of the Candidate



(for mode of payment of fee, pl. refer information brochure)

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