Education is a liberatingforce, and in our age it isalso a democratising force,cutting across the barriers ofcaste and class, smootheningout inequalities imposed by birthand other circumstances.

Haryana IGNOU Society Application Form No. for Community Education &Training (HISCET)

Application Form Control No

[ To be submitted at the HISCET Office]

Session : July / Jan.(Strike out whichever is not applicable)

HARYANA-IGNOU SOCIETY FOR

COMMUNITY EDUCATION AND TRAINING

Photograph

1. Program Code (Fill in the code of the Programme)

2. Enrolment No. (For Office Use Only)

3. Are you already registered with IGNOU Yes No

4. If ‘Yes’, Enrolment No.

Programme Code

5. Name of the Candidate (IN CAPITAL LETTERS)

6. Father’s Name ( IN CAPITAL LETTERS)

7. Mother’s Name (IN CAPITAL LETTERS)

8. Date of Birth

9. Nationality Indian others

10. Sex Male Female

11. Rural/Urban Rural Urban

12. Educational Qualification

13. Details of Demand Darft No. (DD)

Registration fees: DD Date

14. Bank Name & City

S.No. Exam Passed YearBoard /University

SubjectsTotal Marks

MarksObtained

1

2

3

4

Matric

10+2

ITI

Others

(Tick (P) the Appropriate option in 8,9,10)

Percentage

15. Name and complete mailing address of the candidate

Pin code

Mobile No

Phone No with STD Code

E- Mail

16. Are you Bonafide Resident of Haryana? Yes No

17. Category of candidate (AIO/Haryana-General(HG)/SC/BC Backward Class Block-A (BCA) Backward Class Block-B (BCB)

(Refer Reservation norms in prospectus for category code)

18. Sub. Category of candidate Open/ESM/FF

(If candidate is Haryana Domicile) Not Applicable for All India Open (AIO)

19. Type of ESM (Ex. Service man/Ward) Category (If candidate is a Haryana Domicile and Sub. Category is ESM) Not Applicable for All India Open (AIO)(Tick (P) Appropriate option)

i. Ward/children of defense personnel died action iii. Ward/children of Ex/serviceman

ii. Ex- Serviceman Self iv. Ward/children of Para Military Forces

20. Are you physically Handicapped (PH): Yes No

(If candidate is Haryana Domicile) Not Applicable for all India Open. (AIO)

21. Family Income from all Sources (Annually)

Less than or equal to Rs 44500/- More than Rs 100000/- and each less than or equal to Rs 240000/-

Less than or equal to Rs 100000/- More than Rs 240000/-

22. Family Income from all Sources (Annually) for which you can provide annual income proof while reporting or any time when demanded

23. DECLARATIONI hereby declare that I have read and understood the conditions of eligibility for the programme for which I seek admission. I fulfill the minimum eligibility criteria and I have provided necessary information in this regard. In the event of any information being found incorrect or misleading, my candidature shall be liable to cancellation by the HISCET at any time and I shall not be entitled to refund of any fee paid by me to the HISCET. Further, I have carefully studied the rules of the HISCET as printed in the Prospectus and I accept them and shall not raise any dispute in future over the same rules.

(Signature of the Candidate) (Signature of the Parent/Guardian)

CHECKLIST

Before sending the filled in form to the contact centers, please check whether you have: (a) Affixed your Photograph. (b) Enclosed the following attested certificates,

i) Certificates in support of your educational qualification (s) ii) Experience certificate wherever required. iii) Age certificate wherever required. iv) Student Card duly filled in along with photograph. v) Acknowledgement Card duly affixed with the postage stamp for Rs. 6. (c) Attach a Pay Order/Demand Draft in favour Haryana IGNOU Society for Community Education & Training, Manesar, for

Programme Fee and write your name, programme code and application No. on the reverse of the Demand Draft issued by bank .

Attested by

Principal_________________

LATEST PHOTOGRAPH

TO BE PASTED WHICH

WILL BE

ATTESTED BY

UNIVERSITY OFFICE

Enrolment No.__________________________________________________

Name of the Programme __________________________________________

Name _____________________________________________________

Father's/Husband's Name _____________________________________

__________________________________________________________

Address (in Capital Letters)

Indira Gandhi National Open University

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

Pin Code _______________________________________________

------------------?--------------------------------------------------?------------------

Haryana IGNOU Society for Community Education & Training, Manesar

ACKNOWLEDGEMENT CARD

Dear Student,

Thank you for joining HISCET Programme. We acknowledge the receipt of your application form.

Please mention Enrolment Number and the programme applied for in all your future correspondence

with the University.

To be filled in by the Student.

Programme/Course Applied for : ………………………….............

DD/Challan No. : …………………………………..

DD/Challan Date : ………………………………….

Amount : …………………………………

DD Drawn on : …………………………………

For Office Use OnlyYour Enrolment Number is

Please mention your full postal address at the space allocated

HISCET Manesar