CENTRE FOR CHILD PROTECTION

SARDAR PATEL UNIVERSITY OF POLICE,

SECURITY AND CRIMINAL JUSTICE, JODHPUR, RAJASTHAN
(Established by Government of Rajasthan)
From No.
Certificate Course in Child Protection

Application Form/ vkosnu i=

For official use only/ dsoy dk;kZy; ç;ksx gsrq PHOTO
Date: ……………………….…
Admission No. …………………………. Receipt No. …………………………..
Payment of fees: By Check  By Cash 
Signature of in charge
Signed by Applicant

1. Applicant’s Name/ vkosnd dk uke%.............................................................................................

2. Father’s Name/ firk dk uke% ……………………………………………………………………………………………….
3. Mother’s Name/ ekrk dk uke% ……………………………………………………………………………………………..

4. Sex/fyax% Male/ iq#"k  Female/ efgyk  Transgender/ r`rh; fyax 

5. Date of Birth/ tUe frfFk% DD/ fnu  MM/ efguk  YYYY/ o"kZ 
6. Category: General  OBC  SC  ST SBC  Differently Abled 

7. Medium of Study/ ek/;e fganh /Hindi  English 

8. Educational Qualification/ 'kS{kf.kd ;ksxrk

S.l No. Qualification Board/College/University Passing Year Percentage Division

9. Permanent Address/ LFkk;h irk% ……………………………………………………………………………………………………

10. Contact Number/……………………………………….. Email Address………………………………………………………………….
Declaration
I……………………………………........................................ declare that all the information submitted above
are true to the best of my knowledge and I will abide by the rules and regulations of the University.

(Signature of Applicant)
_____________________________________________________________________________________________
In collaboration with UNICEF/ ;wfulsQ ds lg;ksx ls
vkosnu djus ds çdkj% Fill-up the application format and send to ccp@policeuniversity.ac.in , ccp-academics@policeuniversity.ac.in
with self-attested photocopy of educational qualification, ID proof and one recent passport size photo.
Address: Old Campus, Sardar Patel University of Police, Security and Criminal Justice, Rural Police Line,
Daijar, Jodhpur, Rajasthan, Pin Code: 342304,
Website: www.centreforchildprotection.org, https://www.policeuniversity.ac.in/
 CENTRE FOR CHILD PROTECTION
SARDAR PATEL UNIVERSITY OF POLICE,
SECURITY AND CRIMINAL JUSTICE, JODHPUR, RAJASTHAN
(Established by Government of Rajasthan)

Certificate/Diploma Course in Child and Adolescent Counseling

From No.
Application Form/ vkosnu i=
For official use only/ dsoy dk;kZy; ç;ksx gsrq PHOTO
Date: …………………………
Admission No. …………………………. Receipt No. …………………………..
Payment of fees: By Check  By Cash 
Signature of in charge
Signed by Applicant

1. Applicant’s Name/ vkosnd dk uke%.............................................................................................

2. Father’s Name/ firk dk uke% ……………………………………………………………………………………………….
3. Mother’s Name/ ekrk dk uke% ……………………………………………………………………………………………..

4. Sex/fyax% Male/ iq#"k  Female/ efgyk  Transgender/ r`rh; fyax 

5. Date of Birth/ tUe frfFk% DD/ fnu  MM/ efguk  YYYY/ o"kZ 
6. Category: General  OBC  SC  ST SBC  Differently Abled 

7. Medium of Study/ ek/;e fganh /Hindi  English 

8. Educational Qualification/ 'kS{kf.kd ;ksxrk

S.l No. Qualification Board/College/University Passing Year Percentage Division

9. Permanent Address/ LFkk;h irk% ……………………………………………………………………………………………

10. Contact Number/……………………………………….. Email Address………………………………………………………………
Declaration
I……………………………………........................................ declare that all the information submitted above
are true to the best of my knowledge and I will abide by the rules and regulations of the University.

(Signature of Applicant)
_____________________________________________________________________________________________
In collaboration with UNICEF/ ;wfulsQ ds lg;ksx ls
vkosnu djus ds çdkj% Fill-up the application format and send to ccp@policeuniversity.ac.in , ccp-academics@policeuniversity.ac.in
with self-attested photocopy of educational qualification, ID proof and one recent passport size photo.
Address: Old Campus, Sardar Patel University of Police, Security and Criminal Justice, Rural Police Line,
Daijar, Jodhpur, Rajasthan, Pin Code: 342304,
Website: www.centreforchildprotection.org, https://www.policeuniversity.ac.in/