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VIDYASAGAR UNIVERSITYDIRECTORATE OF DISTANCE EDUCATION
APPLICATION FORM FOR ADMISSION
ToThe DirectorDirectorate of Distance EducationVidyasagar UniversityMidnapore - 721 102, West Bengal
Draft / Challan No. .................................................
Amount Rs. .............................................................
Date of deposit ........................................................
Mode of payment : Cash / Bank Draft
Affix here a recentpassport size
photograph dulySigned by the
candidate
I beg to apply for admission to the M.A. / M.Com. / M.Sc. in
for the session(Subject)
at orV.U. CentreHead Quarter
Study Centre at ...............................................................................(Write name of the Institution / Study Centre)
(Please tick which one is applicable)
The detailed information regarding my candidature and background is furnished below :
Date .......................... ...........................................................Signature of the candidate
1. Subject in which admission sought : ..................................................................................
2. Name (in block letters) : ..................................................................................
3. Father's / Mother's Name : ...................................................................................
(in block letters)
4. Address : ...................................................................................
(in block letters and with postal pin code)
(a) Permanent : ...................................................................................
(b) Mailling (For correspondence) : ...................................................................................
(c) Phone / Mobile No. : ................................... (d) e-mail : ............................................................
5. Sex : 6. Marital Status : Married Unmarried
7. Date of Birth : ...................................................................................
(Enclose supporting document)
Male Female Other (give tick mark) (give tick mark)
8. (a) Are you employed any where in any
capacity ? :
(b) If yes, give details including the
name and address of the employer : ...................................................................................
(also Phone No. & e-mail)
9. Institution / College you last attended : ..................................................................................
10. (a) Registration No. at the Institution / : ...................................................................................
College last attended.
(b) Name of the University / Institution last attended : ........................................................................
(c) Class / Course attended there (a) ..................... (b) ..................... (c) .......................
11. Results of your last examination (mention degree with div./class & % of marks) :
(give tick mark)
Yes No
Class Course Session
%
N.B. Incomplete filled-in form will be rejected.
1 17
12. (a) Are you at present a student / an
examinee any where ? : Yes No
(b) If yes, give details including year and month
when this course / examination will be over : ..........................................................................
(Two degrees cannot be offered in the same year)
13. Whether Belong to SC/ ST/ OBC / Minority : SC ST OBCA OBCB Minority
(enclose necessary document).
14. Whether Physically Challanged : Y / N HH VH OH
(give tick mark)
(give tick mark)
(give tick mark)
15. Academic qualifications.
Starting from Madhyamik / equivalent exam. onwards
(Read the Prospectus carefully for eligibility criteria and enclose self Attested copies of supporting documents.)
Exam.passed
Name ofBoard/Council/Univ. Year
Marks
Obtained Out of %Division/
ClassSubject (s)
studied
Serial No. ofthe
encloser
............................................................Signature of the CandidateDate ....................................
Declaration by the CandidateI hereby declare that I have carefully read and comprehended the contents of the admission bulletin and that I shall abide by all the provisions laid down therein.
I understand that if at any stage during the course it is found that I did not passess the required eligibility for admission, or if I do anything in violation of the University Act, Status, Ordinances, Regulations or other rules framed through administrative power, I shall be liable to any disciplinary action deemed fit by the Directorate of Vidyasagar University.
I also declare that all information furnished by me is correct.
Photo
STUDENT INFORMATION SHEETStudents are required to furnish the following information
Signature of the Candidate
Name with Code
1 171. Enrolment No.
2. Study Centre
3. Subject
4. Name
5. S/O/D/O
6. Sex
7. Marital Status
8. Belong to SC/ST/OBC/ Minority
9. Academic Qualification :
10. Employed
11. Location
12. Residence
13. i) Ph. No. / Mob. No. (Mandatory)
ii) e-mail
(In block Letter)
:
:
:
:
:
:
:
:
:
:
:
:
:
M F Other (give tick mark)
Married Unmarried (give tick mark)
SC ST OBCA OBCB Minority (give tick mark)
B.A. B.Com. BSc. Two years Pass Three years Pass General/Hons.(others, if any)
Yes No
Rural Urban
i) District :
ii) State :
Sl. ....................../17
DIRECTORATE OF DISTANCE EDUCATIONVIDYASAGAR UNIVERSITY, MIDNAPORE
Challan for Admission in the Part-I Session-2017-18[Give a tick on the opted subject]
Name :-
Study Centre:- Code
Stream:- [MA/M.Sc / M. Com] Subject:-
Roll:- No.:-
Sl. No.
Subject Part-I
M.A. (Bengali, English, History,Pol.Sc., Sanskrit)
M.Com
M.Sc. (Env. Science, Zoology,Botany, Geography)
M.Sc. (Physics)
01.
02.
04.
05.
03.
06.
M.Sc. (Applied Mathematics withOceanology and Computer
Programming)
M.Sc. (Chemistry)
Total Fees
Late fee
4500*
200Total Fees
Late feeTotal Fees
Sponsred Candidate
Total Fees
Late fee
Total Fees
Late fee
Total Fees
Late fee
4500*
20020350*
26350(only Env. Science)
19750*
200
Late Fees 200
12750*
200
22250*
200
* A candidate seeking admission in desired stream for Part-I will be required to deposit the amount** An additional amount of Rs- 350/- need to be paid as processing charge.
Total Amount (in Rs.) ________________
In words __________________________________
Payment mode:- [Give a Tick on the opted mode of payment]
1. By cash:- Branch Name _________ date __/__/____(Cash can only be deposited in S/B A/C No.-17480100002028 of Directorate of Distance Education, Vidyasagar University, Midnaporeat UCO Bank, Vidyasagar University Branch)
2. By Draft:-(DD can be made from any nationalized bank)OR
a. Bank Name-b. Branch Name-c. DD No.-d. Date:-
Sign. of the applicant
Received the amount Rs. ..............................................................
Date ......................... Signature & Stamp of Bank / Study Centre
Note:1. To be filled in by the applicant and deposited in cash or by Draft at UCO BANK, V.U. Branch (For Admission in Head Quarter).2. Separate Challan to be used for admission and renewal.3. If paid by Draft the information is to be furnished. Study Centre will give receipt.
Part-I : To be retained by Bank/Study Centre
Sl. ....................../17
DIRECTORATE OF DISTANCE EDUCATIONVIDYASAGAR UNIVERSITY, MIDNAPORE
Challan for Admission in the Part-I Session-2017-18[Give a tick on the opted subject]
Name :-
Study Centre:- Code
Stream:- [MA/M.Sc / M. Com] Subject:-
Roll:- No.:-
Sl. No.
Subject Part-I
M.A. (Bengali, English, History,Pol.Sc., Sanskrit)
M.Com
M.Sc. (Env. Science, Zoology,Botany, Geography)
M.Sc. (Physics)
01.
02.
04.
05.
03.
06.
M.Sc. (Applied Mathematics withOceanology and Computer
Programming)
M.Sc. (Chemistry)
Total Fees
Late fee
4500*
200Total Fees
Late feeTotal Fees
Sponsred Candidate
Total Fees
Late fee
Total Fees
Late fee
Total Fees
Late fee
4500*
20020350*
26350(only Env. Science)
19750*
200
Late Fees 200
12750*
200
22250*
200
* A candidate seeking admission in desired stream for Part-I will be required to deposit the amount** An additional amount of Rs- 350/- need to be paid as processing charge.
Total Amount (in Rs.) ________________
In words __________________________________
Payment mode:- [Give a Tick on the opted mode of payment]
1. By cash:- Branch Name _________ date __/__/____(Cash can only be deposited in S/B A/C No.-17480100002028 of Directorate of Distance Education, Vidyasagar University, Midnaporeat UCO Bank, Vidyasagar University Branch)
2. By Draft:-(DD can be made from any nationalized bank)OR
a. Bank Name-b. Branch Name-c. DD No.-d. Date:-
Sign. of the applicant
Received the amount Rs. ..............................................................
Date ......................... Signature & Stamp of Bank / Study Centre
Note:1. To be filled in by the applicant and deposited in cash or by Draft at UCO BANK, V.U. Branch (For Admission in Head Quarter).2. Separate Challan to be used for admission and renewal.3. If paid by Draft the information is to be furnished. Study Centre will give receipt.
Part-II : To be sent to the D.D.E., by Bank/Study Centre
Sl. ....................../17
DIRECTORATE OF DISTANCE EDUCATIONVIDYASAGAR UNIVERSITY, MIDNAPORE
Challan for Admission in the Part-I Session-2017-18[Give a tick on the opted subject]
Name :-
Study Centre:- Code
Stream:- [MA/M.Sc / M. Com] Subject:-
Roll:- No.:-
Sl. No.
Subject Part-I
M.A. (Bengali, English, History,Pol.Sc., Sanskrit)
M.Com
M.Sc. (Env. Science, Zoology,Botany, Geography)
M.Sc. (Physics)
01.
02.
04.
05.
03.
06.
M.Sc. (Applied Mathematics withOceanology and Computer
Programming)
M.Sc. (Chemistry)
Total Fees
Late fee
4500*
200Total Fees
Late feeTotal Fees
Sponsred Candidate
Total Fees
Late fee
Total Fees
Late fee
Total Fees
Late fee
4500*
20020350*
26350(only Env. Science)
19750*
200
Late Fees 200
12750*
200
22250*
200
* A candidate seeking admission in desired stream for Part-I will be required to deposit the amount** An additional amount of Rs- 350/- need to be paid as processing charge.
Total Amount (in Rs.) ________________
In words __________________________________
Payment mode:- [Give a Tick on the opted mode of payment]
1. By cash:- Branch Name _________ date __/__/____(Cash can only be deposited in S/B A/C No.-17480100002028 of Directorate of Distance Education, Vidyasagar University, Midnaporeat UCO Bank, Vidyasagar University Branch)
2. By Draft:-(DD can be made from any nationalized bank)OR
a. Bank Name-b. Branch Name-c. DD No.-d. Date:-
Sign. of the applicant
Received the amount Rs. ..............................................................
Date ......................... Signature & Stamp of Bank / Study Centre
Note:1. To be filled in by the applicant and deposited in cash or by Draft at UCO BANK, V.U. Branch (For Admission in Head Quarter).2. Separate Challan to be used for admission and renewal.3. If paid by Draft the information is to be furnished. Study Centre will give receipt.
Part-III : To be kept for Finance Section (DDE)
Sl. ....................../17
DIRECTORATE OF DISTANCE EDUCATIONVIDYASAGAR UNIVERSITY, MIDNAPORE
Challan for Admission in the Part-I Session-2017-18[Give a tick on the opted subject]
Name :-
Study Centre:- Code
Stream:- [MA/M.Sc / M. Com] Subject:-
Roll:- No.:-
Sl. No.
Subject Part-I
M.A. (Bengali, English, History,Pol.Sc., Sanskrit)
M.Com
M.Sc. (Env. Science, Zoology,Botany, Geography)
M.Sc. (Physics)
01.
02.
04.
05.
03.
06.
M.Sc. (Applied Mathematics withOceanology and Computer
Programming)
M.Sc. (Chemistry)
Total Fees
Late fee
4500*
200Total Fees
Late feeTotal Fees
Sponsred Candidate
Total Fees
Late fee
Total Fees
Late fee
Total Fees
Late fee
4500*
20020350*
26350(only Env. Science)
19750*
200
Late Fees 200
12750*
200
22250*
200
* A candidate seeking admission in desired stream for Part-I will be required to deposit the amount** An additional amount of Rs- 350/- need to be paid as processing charge.
Total Amount (in Rs.) ________________
In words __________________________________
Payment mode:- [Give a Tick on the opted mode of payment]
1. By cash:- Branch Name _________ date __/__/____(Cash can only be deposited in S/B A/C No.-17480100002028 of Directorate of Distance Education, Vidyasagar University, Midnaporeat UCO Bank, Vidyasagar University Branch)
2. By Draft:-(DD can be made from any nationalized bank)OR
a. Bank Name-b. Branch Name-c. DD No.-d. Date:-
Sign. of the applicant
Received the amount Rs. ..............................................................
Date ......................... Signature & Stamp of Bank / Study Centre
Note:1. To be filled in by the applicant and deposited in cash or by Draft at UCO BANK, V.U. Branch (For Admission in Head Quarter).2. Separate Challan to be used for admission and renewal.3. If paid by Draft the information is to be furnished. Study Centre will give receipt.
Part-IV : To be retained by the Applicant
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