II1

III1

II1

III11.III13.

*1

1

1

1

I

1

I14.I17.1

: 8. Enrolment No., ifalready registered in IGNOU

1 9. Programme Code, ifalready registered in IGNOUIT.IIJIJ110. Name1

1

111. Father's / Husband's Name/Mother's Name (Strike out whichever is not applicable)I '

: 12. Address for Correspondence (Do not give Box No. address. Leave a blank box between each unitof address likeHouse No., Street Name, P.O., etc. )1 '

1

1

1

~I~"\)

1

1

I

: 13. Telephone No. (ifany) withSTD Code1 STDCode TelephoneNo. .1 [[[[[] ITJJIIIIJ115. E-MailAddress (ifany) ,

II1

~ FormNo. 76569

INDIRA GANDHI NATIONAL OPEN UNIVERSITYMAIDAN GARHI, NEW DELHI - 110068

APPLICA TION FORM FOR ADMISSIONS - JANUARY, 2007(FOR Programmes except P.HD, MP, MPBF, MEG, MHD, MPS, MAD, MEC, MSO, MPA, M.Sc.(DFSM),

M.COM. MTM, MLIS, BA, B.COM., B.Sc.,BSW, BED, BTS, BLIS and CTPM)Before filling in the form please read instructions on page 175 6. 176, Completed form with copies of certificatesand prescribed programme fee should be sent to the Regional Centre concerned ONLY so as to reach on orbefore the due date notified in the advertisement. Photocopy of the form is not accepted. FO,rmssent to anyother office of the University will not be entertained under any circumstances.

Programme Code

IT.IIJIJ2. Enrolment No

(For office use only

Affixyour latest

passport sizephotograph

(4 em x 5 em)duly attested

by you.

Details of Fees: Tick ( ./) the Appropriate Box only.

Draft D Cash through Bank Challan D3a. For Cash through Bank Challan : Computerised No. I3b. DD Details

DID No. DID Date % Amount (In Rs.)

IT.IIJIJ/ IT] /IT] ITITJ IT.IIJIJDate Month' Year

I Date: I ]

Bank Name

Regional Centre Code IT] 5. Study Centre Code' ITITJMedium Code EngliShD HindiDOthers D Ifothers,pleasespecify(Please ( ./ ) the appropriate box only)

6. State Code IT]

Pin Code

0IIllJ14. Fax No. (if any) with STD Code

DImoIEEtrn

Date Month Year' Male 0 Female 0

18. Nationality: Tick (,() theappropriate Box only

Indian 0 Others 0If other please specify :

.. 16. Dateof Birth

0] 0] ITIIJ17. Sex: Tick (,() the appropriate

Box only

19. Category: Tick (,() the appropriate Box only)

General 0 scO ST0 OBC020. Territory Code: Tick (,() the appropriate Box only)

Urban 0 Rural 0 ' Tribal 0II

21. Whethe"r Kashmiri migrant 0 22. WhetherPhysically Handicapped 0 23. Whether minority C(Tick ( ) if applicable) (Tick ( ) if applicable) (Tick (,() if applicable)

(

29. Details of Scholarship being received if any

(a) Amount I I (b) Govt.l I I (c) Family income(Annually) Deptt. . (Yearly)

30. Course Codes (only for MCAlBCAlPGDDM/CTElDTS/PGDRD/CLD/CAFE/DCElBPP)

DECLARATION BY APPLICANT

I hereby declare that I have read and understood the conditions of eligibility for the programme for which I seek admission. I fulfil theminimum eligibility criteria and I have provided necessary information in this regard. In the event of any information being found incorrector 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 paidby me to the University. Further, I have carefully studied the rules of the University as printed in the Prospectus and I accept them and

shall not raise any dispute in future over the same rules. I I

Date CD I [IJ I CIIIJ CHECKLIST: Signature of CandidateTick the releventboxes

affixedphotograph and signed over it,Attachedthefollowing,D (i) Demand Draft/Challan Form for Programme feel Fee for 1stYearD (ii) Certificates in support of educational qualification(s)D (iii) Experience Certificate wherever requiredD (iv) Category Certificate for SC/STI PH candidates wherever requiredD (iv) Age Certificate wherever requiredD (v) StudentCardduly filled in alongwith photographD (vi) AcknowledgementCard duly stamped

---- --

24. Social Status: Tick(,t) theappropriateBoxonlyEx-serviceman 0 War widow0 'Notapplicable0

25. Marital Status: Tick (,() the appropriateBoxonly 26. Employment Status: Tick(,() theappropriateBoxonly

0 D 0 0 0 0Married Unmarried UnemployedEmployed IGNOUEmployee KVSEmployee

27. Religion: 0 0 0 00 0 0 0 0(Tick (....)the approbox only) 'Hindu Muslim Christian Sikh Jain Buddhist Parsi Jews Others (Please' specify)

-

28. RelevantQualifications (Whichmakes youeligibleforthe programme)

Qualification MainSlJbjects Yearof Division % of marks BoardCode

ITITIPassing 0] 0] [llI].0](Last 2 (01,02,03 or (Do not use (Wherever

Code digits only) 04 for pass) Decimals) required)

MCA CS-60CS-60, 0 CICOCIC .

BCA MTE-03MTE-030 CICOCIC

CTE/DTS Optional =PGDRD/PGDDMCoursesCLD/CAFE Optional DIIIJ DIIIJCoursesDCE Optional DIIIJ DIIIJ DIIIJCoursesBPP OPtional .= =Courses

EXPERIENCE CERTIFICATE(BTCM/BTWRE/PGJMC/B.Sc(N)/CIG/CTE/PGDMCH/PGDHE/PGDHHM/CCEANMIDNA)

This is to certified that Mr.fMs.lMrs.

schoolllnstitution/Organisatio!1/0ffice/Hospitalas

is employed with this

since

Place:

Date:Signature:Name:

(in Block letters)

Designation:Name of School/Institution/

~ Organisation/Office/Hospital(Seal/Stamp)

(Self employed professional may certify on their own behalf,

but they should attach copies of their Registration Certificates.)~ K-~---

CATEGORY CERTIFICATE(SC/ST Candidates)

son/daughter/wife

of Village Town

Distt. State/U.T. belongs to

- Caste which is recognised as Scheduled Caste/Scheduled Tribe under the

I

Constitution(Scheduled Caste Part C States) Order 1951 readwith the SC/ST list (Modification,Order,1956)

Mr.lMs.lMrs and his/her family reside in

VillagelTown District StateU.T.

This is to certify that Mr.lMs.lMrs.

of Shri

(Signature of Tehsiidar/CQmmissioner/District Magistrate)

Place:

Date:Signature:

Seal/Samp

K ~-----EMPLOYMENT CERTIFICATE

(Forapplicantsof CWDL& belongingto any departmentof GOI,seekingsponsorship)

Thisis to cerfitythat is workingas inVillage

, Distrfct

(Signature & seal of Competent Authority)

INSTRUCTIONS

1. This card should be produced on demand atthe Study Centre and Examination Centre or anyother Establishment of IGNOU to use itsfacilities.

2. The facilities would be available only relatingto the course or courses for which the student

is actually registered.

3. Duplicate Identity Card ,will be issued by theRegional Director, on payment of Rs. 201-by wayof Demand Draft only in favour of IGNOU payableat the city where Regional Centre is located.

4. Loss of Identity Card is to be reportedimmediately to the nearest Police Station.

5. Identity Card is to be submitted to the issuingauthority after completion of the saidprogramme.

~INDIRA GANDHI

NATIONAL OPEN UNIVERSITY

STUDENT CARD

'. . . , - . w... . . . . . . . . . . . . .". . - . . . - . ~7" '... -. - . --c. - -. .. . . . - . .. . . . . . - . . . . . ., .. . . . . . . . . .

Indira Gandhi National Open University

ACKNOWLEDGEMENT CARD

Dear Student,

Thank you for joining IGNOU Programme. We acknowledge the receipt of your application form. Please mentionEnrolment Number and course applied for in all your future correspondence with the University.

.. To be filled in by the Student. ....For Office Use Only

Course Applied for

DD/Challan No.

. "......

DD/Challan Date

. ... ... "'"''''''''''''''''Your EnrolmentNumber is

. ..........................

Amount

DO Drawnon

. ,...

. . ............. .............

Enrolment No.

Nameof the Programme PASTE

Name

Fathers/Husband'sNqme

Address (in Capital Letters)

LATEST PHOTOGRAPH TOBE PASTED WHICH WILL BE

ATTESTED BYUNIVERSITY OFFICE

Pin Code ATTESTED BYREGIONAL DIRECTOR_-INDIRA GANDHI NATIONAL OPEN UNIVERSITYFullSignatureof the Candidate

..... - . . - - . . - . - . . . . . . . . . ., - . . . . -. - -.. -' -. - . . - - ::. ~. - -.. . - ., ".' - 'J-. -.' . . . . 'c' ,

Please mention your full postal address at the space allocatedAffix

Postagestamp for

Rs 6/-To

CITY:

FromThe Regional Director,IGNOU Regional Centre

STATE:

PIN: