7. Enclosures (Attested copy of ) : i.

Proof of Residence

ii. 10
th
& 10+2 Certificates


iii. Category certificate
iv. Character Certificate
v. Any other relevant certificate
YMCA UNIVERSITY OF SCIENCE & TECHNOLOGY
(Established by Haryana State Legislative Act No.21 of 2009,
Approved by AICTE & Recognized by
U.G.C. U/s. 2(f) and 12(B) of U.G.C. Act 1956)

APPLICATION FORM FOR ONE YEAR FULL TIME DIPLOMA COURSE


(Last Date for Applying: 15
th
Aug, 2014)





Course: [Tick () for appropriate]
1. Diploma in Welding [ ]
2. Diploma in Electrician [ ]
Affix a Passport
size Photograph
(attested).

Four Passport size
photographs will
also be required at
the time of
admission.

1. Name in Full (in block letters) :

2. Fathers Name (in block letters) :

3. Date of Birth (dd/mm/yyyy) :

4. Category(GEN/SC/BC/PH/EBP/SBC) : __

5. Address for correspondence :

PIN


Ph. No. Mob. No. Email Id: __

6. Details of Educational Qualification:
Examination Year of
passing
Name of the
Board/College/
University
Marks
Obtained
Maximum
Marks
% Marks
10
th

12
th

Any other
Qualification










I declare that entry made by me in this admission form and the document submitted by me with
admission are true in all respect and in any case, any information is found to be false, this shall entail
automatic cancellation of my admission.




Date: Signature of the Applicant
Place: