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UTTARAKHAND OPEN UNIVERSITY HALDWANI, NAINITAL Website: http://uou.ac.in Email Id: info@uou.ac.in Contact No.

: 18001804025

Admission Form for Semester Programs Only


Last Date For Form Submission: 15th April, 2011
1. Enrollment Number ukekadu la[;k

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3.
Study Centre Name Study Centre Code

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4. Program Applied For

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Program Code

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Year/ Semester

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5. Demand Draft Details fMekaM MkV dk fooj.k Issuing Bank DD No. Date Amount

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6. Students Name vH;FkhZ dk uke 7. Fathers/ Husbands Name firk@ifr@ dk uke 8. Mothers Name ekrk dk uke 9. Mobile Number Ekksckby u0

10. Complete Address for Correspondence i= O;ogkj gsrq iw.kZ irk

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11. Particulars of the Present Programme applied for (Semester-Which ever applicable) S.No Course Code Course Title Semester

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12. Course in Which Candidate Appeared in Previous Exam Course Title Year/ Semester S.No

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13. Details of Counseling in Previous Semester S.No Course Title

No. of Counseling Attended

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Date: Place:

Signature of the Applicant

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I hereby certify that Mr. /Ms/Mrs. /Dr. ________________________________ son/daughter/wife of ________________________________ enrolled for this study centre .He/she has been found eligible to be admitted in the. Semester of . Program.

Signature Study Centre Coordinator