7

INTERNATIONAL STUDENTS CELL

JCT ENABLED DISTANCE PROGRAMMS OF CDE
ACHARYA NAGARJUNA UNIVERSITY :: NAGARJUNA NAGAR - 522510, AP.
ADMISSION APPLICATION FORM

Provisional Number
For Office Use Only
University Enrollment Number

I I I I I I I I I I I I I I I I I I I I I I I
DOB, PC, Marks
Certif icate Verified by Name '----------� Signature
I I I'--------'I BJ eD Batch

EAR
Admission given by Name I f
ignature I Y

NOTE: Plea se fill only in Engli sh with CAPITAL letter s. Read the Instructions overleaf 6 Pro spectu s carefully before filling thi s form
To be Filled by Student

�- � -�
1. Code No. of the Course Applied -
(See Prospectus for codes) ...... I I I
. I I I I
2. Choice o f Exam centre
I Priority Ill Priority

3. Fee Particulars
II Priority

DD No./ Online Transaction No. Day Month Year Amount

I I I I I I I I I I DJ DJ 1 21°1 I I I I I I I I
Name of the Issuing Bank Y
I I I I I I I I I I I I I I I �trffi12 10 I I l-[D
AR

4. Medium of lnstrucOon : Engllsh Only 5. Second Language : S=Sanskrit T=Telugu H=Hindi

(In case of UG Courses)
6. Name of the Candidate and Father's Name (CAPITAL LETTERS ONLY) as per SSC or its equ ivalent examination/ Notary
D
Na�: of
Candidate
I I I I I I I I I I I I I I I I I I I I I I I I I I I
����r's
I I I I I I I I I I I I I I I I I I I I I I I I I I I
I I I I I I I I I I I I I I I I I I I I I I I I I I I
7.Sex

M=Male
F = Female D
8. Marital

M = Married
U=Un-Married
Status

D
rn -rn-1
(As per enclosed Proof)
9. Date of Birth

Month
1
Year
9
I I I I rn
10.Reservation
Category
Code
11. Religion

12. Nationalityrn
I
13.Details of Qualify ing Examination Passed:
Quahpfy' ing Exam I I I
R e g d . No. of
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1 ����1-�I
a s sed Q ualifying E x am
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Year of Passing
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GROUP SUBJECTS
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T cE T t. o
l 1 1 1 1 1 1 l 1 1
Marks Obtained

I I I II I I I I 1�::�i�1gl I I I 1 3 ·�1 ��-���'�

Rank

14.Address for Communication

Door No./
Clo Paste Recent

House No.
Passport size
Photograph ONLY

Street I Village!
within this box.

Mandal/Town I
Do not staple / pin &
:=::::;:::=:===::=:::=::::;:::::::::;:==:=:::=:::::=::::::;:��:::;::::::::::;:::::::::;:=::=:::::=:::::::::===::=:::=::::;:::::::::: Do not sign on

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the Photograph

IN
District Code
Phone
(if any) STD Code Phone No.
Mobile No. I I I I E-mail ID: ___________
(If any) Signature of tlte Candidate
L (inaide the box above) _J