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APPLI FORM DEP Cirtificate 14-15

This document is an application form for admission to vocational programs offered through the Distance Education programme at Dayalbagh Educational Institute for the 2014-2015 session. The form requests information such as name, address, family details, academic qualifications, category and religion. It includes declarations by the student and parents/guardian. Required enclosures with the application are also listed.

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MaaLalta Kisan Producer Company Limited
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110 views2 pages

APPLI FORM DEP Cirtificate 14-15

This document is an application form for admission to vocational programs offered through the Distance Education programme at Dayalbagh Educational Institute for the 2014-2015 session. The form requests information such as name, address, family details, academic qualifications, category and religion. It includes declarations by the student and parents/guardian. Required enclosures with the application are also listed.

Uploaded by

MaaLalta Kisan Producer Company Limited
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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DAYALBAGH EDUCATIONAL INSTITUTE

(DEEMED UNIVERSITY)
DAYALBAGH, AGRA – 282 005

DISTANCE EDUCATION PROGRAMME


SESSION: 2014 – 2015

APPLICATION FOR ADMISSION TO:


Vocational Programme: Dress Designing & Tailoring / Modern Office Management & Secretarial
Practice/ Motor Vehicle Mechanic: Four Wheeler/ Textile Designing & Printing / Wireman/ Textile
Technology / Electrician / Office Assistant cum Computer Operator/ Cutting & Sewing Programme*

1. NAME: Mr./ Ms. /Mrs._______________________________

2. (a) Mailing Address:___________________________


________________________
________________________
_____________________ AFFIX YOUR RECENT
Tel. No.: _____________ PHOTOGRAPH
(b) Permanent Address:___________________________
________________________
________________________
_____________________
Tel. No.: _____________

3. Father’s Name: Shri ________________________

4. Mother’s Name: Mrs. __________________________

5. Guardian’s Name (if father is not Guardian) : Shri ________________________

6. (a) Occupation: ___________________________ (b) Income Rs. ___________P.M.

7. Mention Category to which: Gen./ SC/ST/OBC 6. Religion: _________________


You belong

7. (a) Date of Birth: ________________ (b) Age (as on 1.7. 2014): _______ yrs.

8. Academic Qualification:

Examination School/ Board/ Passing Marks Subjects


Passed University Year (%)

VIII

High School or
Equivalent

Inter or Equivalent

B.A./B.Sc./B.Com.*

Any Other

9. Details of Merit certificates / Trophies / Prizes won:

___________________________________________________________________________________________

* Strike off which is not applicable


DECLARATION BY THE STUDENT

1. I certify that the information furnished in this application has been filled in by me and that the entries
made are correct.
2. I fully understand that my admission in this programme will be cancelled, if it is discovered at a later
date, even after the completion of the programme of study, that the admission was obtained by me
by fraudulent means or by misrepresentation of the facts. In such a case, I shall forfeit all accruing
benefits and if the certificate has been awarded, it will be cancelled.

Place: __________________

Date: ___________________

Signature of Applicant

DECLARATION BY THE PARENTS / GUARDIAN

In the event of my ward _______________________________________________________ being


admitted to the programme Dress Designing & Tailoring / Modern Office Management & Secretarial
Practice/ Motor Vehicle Mechanic: Four Wheeler/ Textile Designing & Printing / Wireman / Textile
Technology / Electrician / Office Assistant cum Computer Operator/ Cutting & Sewing Programme run by
Dayalbagh Educational Institute (Deemed University) at its _________________________________Centre,
I shall be responsible for his conduct and behavior during his study at the Centre and undertake to pay
without demur all his dues for the entire period of the programme.

Place: __________________

Date: ___________________

Signature of Parent/Guardian

Enclosures: Attested Copies of:-

1. Bonafide student / Character Certificate from the Head of the Institution last attended.
2. Mark Sheet/ High School, Intermediate and Bachelor’s examinations.
3. Certificate of being a Scheduled Caste/Scheduled Tribe/Backward Class, if any.
4. Certificates of Games/Sports
5. Income Certificate of Parent / Guardian.
6. Any other.

Strike off whichever is not enclosed with the application

For details refer to Information Booklet provided on DEI Distance Education website.

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