ANITECH-SDT-KSOU-Application form

					       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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