Srinivasavanam:: Kuppam 517 426, Chittoor Dist (A.

P)

DRAVIDIAN UNIVERSITY
Directorate of Distance Education (DDE)

APPLICATION FORM FOR U.G/P.G REGULAR ADMISSION - 2013-14

Name of the Centre/Code:

Reg.No.

1. Name of the Applicant:______________________________________________ (In Block Letters only) 2. Fathers Name:____________________________________________________ 3. Name of the Course: 4. Medium: _______________ 5. Date of Birth: 6. Social Status: 7. Gender:
Male

Subject: Subject Code:

Affix recent passport size photo with Gazetted Officers attestation.

SC ST
Female

BC

OC

Sub-Caste:

8. Address for Correspondence:____________________________________________________________ _____________________________________________________________________________________ Phone/Mobile No :_________________________________E-mail:______________________________ 9. Educational Qualification: Name Duration Examination of the of the Passed Course Course S.Sc/ Equivalent Intermediate Degree Others (specify) 10. Fee Particulars: Bank/Branch____________________________________DD No:__________________ Date:_____________Amount:______________ DECLARATION I declare that all the information submitted in this application form is correct and complete. I acknowledge that Dravidian University reserves the right to withdraw or cancel a course, in case of adequate / minimum admissions are not enrolled in any course. I declare further that I had read and understood all contents of this application form and information Brochure and that I am bound by all their contents for all purposes. Place: Date: For Directorate Use Name of the Course: Admitted Yes ______________ No______ Register Number: Original Certificates verified by Signature of the Dealing Assistant: Signature of the Admission Officer

Name of the Institution College/University

Year of Passing

Subjects

Grade/ Percentage

Class

Signature of the Candidate

INSTRUCTIONS TO THE CANDIDATES:

1. Name of the applicant & Fathers name are to be filled in Block letters. 2. All U.G & P.G Courses except the Languages are offered only in English &Telugu Medium. 3. Name of the Course applied must be specified in capital letters. 4. Social status and Gender must be clearly stated. 5. Address for correspondence must be mentioned completely along with the pin code. 6. Educational qualifications should be stated clearly with all particulars. Photo copies of the certificates of the qualifications have to be enclosed. 7. Refer to the eligibility details before submitting the application form. 8. Fees once paid will not be refundable. 9. 2 Passport size photos (one affix on the application form and one on the identity card). 10. The University reserves the right of cancellation of admission of the candidate if any wrong information found. 11. Students of one study centre where adequate No. of students are not available would be allotted to other Study Centres Examination to attend their examination. 12. Filled in Applications should be submitted to any one of the Study Centres along with their code number. For Study centres and its code numbers visit www.dravidian university.ac.in.