mkjk[k.

M eqDr fo'ofo|ky; Summer Winter

xzh"edkyhu 'khrdkyhu
UTTARAKHAND OPEN UNIVERSITY
leLr ikB~;eksa gsrq os'k vkosnu&i=k (Admission Form for All Programmes)
l=k (Session) 2016-17
iQkeZ ua0
ukekadu la[;k
Enrolment No.
Form No. 16
funs'Z k (Instructions) ikliksVZ lkbt (4x5)ls-eh-
viuk Lo;a izekf.kr iQksVks
1. d`i;k iQkeZ Hkjus ls igys foojf.kdk esa fn;s x, funsZ'kksa dks i<+saA fpidk,
Before filling the form please read the instructions given in the Prospectus. Paste your Latest
2. iQkeZ dSfiVy ySVj esa Hkjsa rFkk dkys ckWy isu dk iz;ksx djsaA Passport Size (4x5cm)
Use the black ball pen and Capital Letters for filling this form Photograph Duly
Attested by Yourself
3. iQksVks dks LVsiy u djsaA
Do not staple photograph.
4. iQkeZ esa leLr fof"V;ka Hkjh tkuh vko';d gS] tks lwpuk ykxw u gks ml
dkye esa N.A. (ykxw ugha) fy[ksaA viw.kZ ,oe~ vLi"V iQkeZ Lohdk;Z ugha gksaxsA
(Filling of all entries in the form is mandatory, fill N.A. if not applicable. vH;FkhZ ds Li"V gLrk{kj
Incomplete forms will not be accepted)
5. os'k iQkeZ lHkh layXudks ds lkFk lEcfU/r v;;u dsU ls lR;kiu ,oa vxzlkj.k ds fcuk Lohdk;Z ugha gksaxsA
(Admission forms and enclosures without verification and forwarding of the concerned study centre will
not be accepted)

1. {ks=kh; dsU dk uke (Name of the Regional Centre) {ks=kh; dsUs dk dksM (Regional Centre Code)

2. v;;u dsU dk uke (Name of the Study Centre) v;;u dsUs dk dksM (Study Centre Code)

3. ikB~;e dk uke (Programme Applied for) ikB~;e dksM (Programme Code) o"kZ@lseLs Vj (Year/Semester)

4. ek;e (Medium) : vaxt

zs h (English) fgUnh (Hindi)
5.cSad pkyku dk fooj.k (Bank Challan Particulars)
,l-ch-vkbZ-(SBI) ch-vks-ch- (BOB) tuZy uEcj (Journal No.) fnukad (Date) /ujkf'k (Amount)

6. uke (fgUnh es)a ----------------------------------------------------------------------------------------------------------------------------------------------------------------------

Name (in English)

7. firk dk uke (Father's Name)

8. ekrk dk uke (Mother's Name)

9. fyax (Gender) : iq#"k (Male) L=kh (Female)

10. tUe&frfFk (Date of Birth) (DD/MM/YYYY)
11. dkWUVsDV ua0 (iQksu) (Contact No.) : 1.

2.
12. bZ esy (Email ID)

13. vk/kj dkMZ la[;k (Aadhar Card No.)

14. vH;FkhZ dk cSd
a [kkrk fooj.k 'kqYdkfn okilh gsrq (Bank A/c details of applicant for refund of fees etc.)%
cSd
a dk uke (Name of Bank)_________________________________ IFSC Code____________________
[kkrk/kjd dk uke (A/c Holders Name) : __________________ [kkrk la[;k (A/c No.) __________________

15. ukxfjdrk (Nationality) % Hkkjrh; (Indian) ,u-vkj-vkbZ- (NRI) vU; (Other)________

 (2)
16. (a) Js.kh (Category) : lkekU; (GEN) vU; fiNM+k oxZ (OBC) vuq- tkfr (SC)
vuq-tutkfr (ST) vU; (Any other)_______________________________
(b) ;fn vki fodykax gSa rks (Whether Physically Handicapped) : gk (Yes) ugha (No)
17. {ks=k (Area) : xzkeh.k (Rural) uxjh; (Urban)
18. /eZ (Religion) : fgUnw (Hindu) eqfLye (Muslim) bZlkbZ (Christian) vU; (Others)____
19. vkthfodk fLFkfr (Employment Status) : vkthfodkghu (Unemployed)
vkthfodk izkIr (Employed) m0eq0fo0fo0 dehZ (UOU Employee)
20. OkSokfgd fLFkfr (Marital Status) : fookfgr (Married) vfookfgr (Unmarried)
21. i=k O;ogkj@v;;u lkexzh kIr djus gsrq iw.kZ irk (Address for Correspondence/Study Material )

Pin Code
22. LFkk;h irk (Permanent Address)

Pin Code
23. 'kSf{kd ;ksX;rk (Academic Qualification) d{kk o vkxs (Class 10 onward)
10
izkIrkadks dk
ijh{kk dk uke mkh.kZ djus cksMZ fo'ofo|ky; dk izfr'kr Js.kh eq[; fo"k;
(Name of dk o"kZ (Year uke (Name of Board/ (Aggregate (Division) (Main Subjects)
Examination) of Passing) University) Percentage)

24. ;w-vks-;w- vgZrk ikB~;e mkh.kZ djus dk o"kZ (Year of Qualifying Bachelor's Preparatory Programme from UOU)
o"kZ@l=k (Year/Session) ukekadu la[;k (Enrolment No.) ikB~;e dk uke (Name of the Programme)

25. (a) vkosfnr dk;Zeksa dk fooj.k& (okf"kZd@lsesLVj tks Hkh ykxw gks) :
Particulars of the Present Programme applied for (Year/Semester-Which ever applicable) :
0 l0 iz'u i=k dk dksM iz'u i=k dk 'kh"kZd o"kZ@lsesLVj
Year/Semester
(Sl.No.) (Course Code) (Course Title) (Whichever Applicable)

25. (b) ch0,0 laxhr (Loj ok|) gsrq p;fur ok| dk uke& :................................................................................
Name of musical instrument for B.A. Music (Tonal Instrument)_________________________________
 (3)

26. D;k vki dHkh fdlh U;k;ky; }kjk nafMr fd;s x;s gSa @ fdlh 'kSf{kd laLFkk ls c[kkZLr fd;s x;s gksa ;k vU; ekeyksa
esa vijkkh fl fd;s x;s gkssA :
Whether you are expelled / restricted from any educational institute or convicted by a court
of law or if any case is pending against you in a court of Law ?

gk (Yes) ugha (No)

;fn gk rks fooj.k izLrqr djsa & If yes, give details -

For Management Programmes Only (dsoy izcU/ ikB~;eksa ds fy,)

To be compulsorily filled by learner (fuEu fooj.k vfuok;Zr% Hkjuk gS)

1. Year & Month of Qualifying M.B.A. Entrance Test

,e0ch0,0 os'k ijh{kk mkh.kZ djus dk o"kZ rFkk ekg---------------------------------------------------------------------------------------------------
2. MAT/CAT Score (if candidate have not attempted entrance test UOU)
eSV@dSV izkIrkad] (;fn vH;FkhZ us bl fo0fo0 dh izos'k ijh{kk esa Hkkx u fy;k gks)-----------------------------------------------
3. Year and Month of qualifying MAT/CAT Score (Attach a copy of result card)
eSV@dSV ek;e mkh.kZ djus dk o"kZ vkSj ekg fy[ksa rFkk fjtYV dh Nk;k izfr layXu djsa--------------------------------------
4. Year of qualifying BCPP (for non 10+2 applying for BBA) (Attach a copy of certificate issued)
ch0lh0ih0ih0 ds mkh.kZ dk o"kZ& ch0ch0,0 ds fy,] tks 10+2 mkh.kZ u gksa (izek.k i=k dh Nk;kizfr layXu djs)a
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
5. Total Number of Years Teaching / Supervisory / Managerial / Professional Experience
v;kiu @ fujh{k.k @ cU/dh; @ O;kolkf;d vuqHko ds dqy o"kksZa dh la[;k--------------------------------------------------------
6. Organization / Institution served or owned
laLFkk dk uke tgka vkius dk;Z fd;k gks@Lo;a dh laLFkk

laLFkk dk uke dc ls dc rd Work /kfjr in dk uke

(Organisation) experience (in year) (Name of Position Held)

7. Area of experience : (HR, MM, MF or any other, specify) vuqHko dk {ks=k &
.................................................................................................................................................................................................

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

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 (4)
vH;FkhZ }kjk ?kks"k.kk (Declaration by the Applicant)
1) eSa ,rn}kjk fof/or ?kks"k.kk djrk gw @ djrh gw fd mi;ZDq r nh x;h lHkh lwpuk,a lR; gSAa rF;ksa dks fNik;k ;k xyr
rjhds ls izLrqr ugha fd;k x;k gSA eSua s foojf.kdk esa izo's k izf;k lEcU/h lHkh lwpuk,a rFkk rF; i<+ fy;s gSa rFkk eSa
budk vuqikyu d#axk @ d#axhA ;fn dh xbZ fof"V;ksa rFkk layXud ek.k&i=kksa esa dksbZ =kqfV@folaxfr ikbZ tkrh gS rks
esjk izo's k fujLr dj fn;k tk;A ,Slh fLFkfr esa eSa 'kqYd okilh ds fy,s fdlh Hkh izdkj dk nkok ugha d#axk @ d#axhA
2) eSa ;g ?kks"k.kk djrk gw @ djrh gw fd eSaus lHkh Lo&ekf.kr izi=k bl vkosnu i=k ds lkFk layXu dj fn;s gSa rFkk
bu layXudksa dh ewy fr v;;u dsU dks lR;kiu gsrq Lrqr dj nh gSA
3) fo'ofo|ky; fu;ekoyh ds rgr fu;ekuqlkj dh xbZ fdlh Hkh izdkj dh vuq'kklfud dk;Zokgh eq>s Lohdk;Z
gksxhA
4) eSa lHkh fu;eksa @ fu.kZ;ksa vkSj fofu;eksa dk ikyu d#axk @ d#axhA
1) I hereby declare that the particulars stated in this application form are true to the best of my knowledge and
belief. I have read the prospectus and the admission/ eligibility requirements as laid down by the University
and I shall abide by them. In the event of suppression or distortion of any fact in my application, my admission
will stand cancelled at any point of time. In case my admission is cancelled by the University due to any reason,
I shall have no claim for refund of fee paid by me.
2) I hereby declare that I have attached all the required self-attested documents with this form and also
provided the orignal documents to the study centre for verification.
3) Further, I declare that I shall submit myself to any disciplinary action under the Act, the Statutes and the
Ordinances framed by the University.
4) I agree to abide by the rules and regulations of the University.

LFkku (Place) & vH;FkhZ dk uke (Name of the Applicant)----------------------------------------------

fnukaad (Date) & vH;FkhZ ds gLrk{kj (Sign. of the Applicant)------------------------------------------
v;;u dsU }kjk lR;kiu ,oe~ vxzlkj.k ek.k&i=k
(Verification and forwarding Certificate by the Study Centre)

eSa (leUo;d) ,rn~}kjk Jh@Jherh@lqJh (vH;FkhZ dk uke)--------------------------------------------------------------------------------------iq=k@iq=kh@iRuh

-------------------------------------------------------tks bl v;;u dsU (dksM lfgr)-----------------------------------------------------------------------------------esa
ikB~;e-----------------------------------------------------------esa ukekafdr gq, gS]a dk os'k vkosnu i=k vxzlkfjr djrk@djrh gwA esjs }kjk
bl os'k iQkeZ dh leLr fof"V;ksa rFkk layXu ek.k&i=kksa dk ewy ek.k&i=kksa ls feyku dj lR;kfir dj fy;k x;k gSA
I (Coordinator, study centre) hereby forward this admission form of Mr./Mrs./Ms. ..............................................................
Son/Daughter/Wife of.....................................................for admission in (name of study programme).....................................
at (study centre name/code)......................................................................................... All the entries in this form and
attached testimonials have been verified by me after comparing the same with the original documents.

LFkku (Place) & v;;u dsU leUo;d dk uke.................................................

Name of Coordinator, Study Center

fnukaad (Date) & v;;u dsU leUo;d ds gLrk{kj

Sign. of Coordinator, Study Center..............................................

eksgj (Seal)
fo'ofo|ky; os'k dk;kZy; mi;ksxkFkZ
For University Admission Office Use

Jh@Jherh@lqJh--------------------------------------------------------iq=k@iq=kh@iRuh--------------------------------------------------------dks os'k vkosnu i=k

,oa layXudksa ds ijh{k.k mijkar ikB~;e------------------------------------------------------------------------------------------esa os'k nku fd;k
tkrk gSA Jh@Jherh@ lqJh--------------------------------------------------------dks iathdj.k la[;k---------------------------------vkoafVr dh tkrh gSA
Mr./Mrs./Ms. ..................................................Son/Daughter/Wife of...............................................is granted admission in
study programme....................................................after scrutiny of this admission form with attached testimonials.
Mr./Mrs./ Ms. .......................................................is being allotted Enrolment No. .......................................

fnukad@Date : ..............................

dk;kZy; lgk;d@Office Assistant

Verification by 1...................................... Hkkjh] os'k vuqHkkx
In-charge, Admission
2......................................

u;s ikB~;e esa os'k gsrq vko';d nLrkost %

1& gkbZLdwy ;k led{k ijh{kk dk ek.k&i=
2& gkbZLdwy ls vgZrk ijh{kk rd dh vadrkfydk;sa
uksV %& bu nLrkostksa dk ewy ls feyku dj lR;kiu djuk v;;u dsU dk vfuok;Z nkf;Ro gSA
List of mandatory testimonials for Admission to New Programmes:
1) High School or equivalent Certificate.
2) All Marks Sheets from High School up to the Qualifying Exams.
Note :- It will be mandatory for the Study Centre to verify all testimonials after careful inspection
of the Originals.