KARNATAKA STATE OPEN UNIVERSITY Appl No. Manasagangotri, Mysore- 570006 In collaboration with SHREE DEVI TRUST No. 672, 2nd Floor, 11th Main, Jayanagar 4th Block Bangalore – 560 011 APPLICATION FORM Application for Admission To…………………………………….Programmes 20 - 20 STUDENT'S PERSONAL INFORMATION (PLEASE FILL IN BLOCK LETTERS) 1. NAME: 2.ROLL NO: 3. DATE OF BIRTH: 4.KARNATAKA: Tick OTHER STATE: (as per marks card) 5. PROGRAMME OPTED SEMESTER 6. PLACE OF BIRTH & DISTRICT 7. MOTHER TONGUE: 8. SEX: MALE FEMALE 9. NAME OF FATHER / GAURDIAN /HUSBAND 10. NAME OF MOTHER 11.NATIONALITY INDIAN NON-INDIAN 12. POSTAL ADDRESS OF APPLICANT Pin Code 13. CONTACT NUMBERS OFFICE MOBILE (With STD code) . RESIDENCE E-MAIL 14. CATEGORY (Tick the box) SC ST OBC GM 15. ANNUAL INCOME 16. WHETHER (Tick the box) PHY. CHALLENGED DEFENCE EX. SERVICE MAN 17. ADMISSION CYCLE 1ST CYCLE Jan 2ND CYCLE July Papers Offered 18. QUALIFYING EXAMINATION PASSED 1 2 Reg.no & Marks % of Class Board / University Examination Passed Year of Passing obtained Marks obtained 3 4 5 6 7 Full Time Part Time Business Agriculture Unemployed House Wife Retired Other 19. APPLICANT’S Service Service PROFESSION (TICK) 20. FEE PAYMENT DETAILS(KSOU SHARE)[Do not fill this section if payment is done online] SL. TYPE OF FEE AMOUNT FEE PAID D.D NO. No. (Rs.) 1 PROGRAMME / TUITION FEE DATED 2 REGISTRATION FEE 3 ELIGIBILITY / NRI / FOREIGN STUDENTS (ELIGIBILITY FEE FOR NON-KARNATAKA ONLY) BRANCH OF REMITTANCE 4 PENAL FEE 5 EXAMINATION FEE NAME OF THE BANK TOTAL 21. FEE PAYMENT DETAILS(SDT SHARE)[Do not fill this section if payment is done online] SL. TYPE OF FEE AMOUNT FEE PAID D.D NO. NO. (Rs) 1 PROGRAMME/TUITION FEE DATED TOTAL BRANCH OF REMITTANCE SPECIMEN SIGNATURE: 1. 2. NAME OF THE BANK PLACE: DATE: Signature Of The Applicant Important Instruction & Basic Rules University A candidate seeking admission to any of the program should fill in the admission form in capital letters after carefully reading the prospectus and the program he/she wishes to study in the space provided for the purpose and attached enclosures (I) Qualifying Marks Cards (Attested), (II) Transfer Certificate (Original)(III) Caste Certificate (for Karnataka student) (Attested). (IV) Four Stamp Size Photographs (Write your name & Application No. on bank side of the Photo) Candidate while sending the application form shall follow the instruction given below: a) The application form duly filled in should be submitted to SDT on or before the last date as mention in the advertisement / academic calender available on SDT / KSOU website. Admission made to any program is provisional till the time University finally approves it. Candidate are required to preserve carefully the fee receipt and photocopy of DD for all payments made to the SDT and KSOU, as it is the only valid document accepted. They may have to produce it at the time of obtaining the examination admission ticket, marks sheet or any other documents. Identity card bearing Permanent Roll No. will br issued to every candidate after the admission is finalized by KSOU. Till such time the provisional. Program fee has to be paid with the application number on the bank of the DD. Fee once paid will not be refunded under any circumstances. You refer the prospectus and the website for complete rules and regulations of the university and other details. Visit KSOU website: www.ksoumysore.com and www.ksoustudycenters.com, www.ksouneed.com regularly for updates.
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