Admission Form  (Distance Education) JUL-2018
College And Course Details
District*
College Name*
Program Name* Select Branch*
Year*
Admission Type* Medium*
Personal Details
First Name Last Name
Name in Hindi*
DOB* Gender*   Domicile*    
Father's Name* Mother's Name*
Marital Status* Husband's Name
Category*  
Sub-Category Minority  Handicapped Freedom Fighter Employee Ward (Only for Jiwaji University Employees) Blind
Nationality* Religion*
Address
Correspondance
* *
* *
* *
Permanent
* *
* *
* *
Other Details
Phone Number(With STD Code) Mobile Number*
Email Id*  
Previous Education Details
Exam Passed*
University/Board*
Passing Year* Percentage*  .  %
Eligibility/Migration/Transfer Certificate No.* JIwaji Univ Previous Roll No(For Ex)

Enclosures
Eligibility certificate?
Migration certificate?
Proof for DOB?
Marksheet?
Gap Certificate?
Photo & Signature
I hereby declare that the information filled by me is true and complete as per my knowledge. If any information provided by me is found false or incorrect then i shall be disqualified by the university.