LdkWyj uafjDr NksM+sa

/ Scholar No.
(Leave Blank)

dk;kZy; mi;ksx gsrq

(For Office use only)

VARDHAMAN MAHAVEER OPEN UNIVERSITY

Rawatbhata Road, Kota - 324021 (Raj.)

o/kZeku egkohj [kqyk fo'ofo|ky;

jkorHkkVk jksM]+ dksVk&324021 jkt-

iz o s ' k vkos n u i=

Lo;a ds gLrk{kj }kjk

izekf.kr ikliksVZ
lkbZt dk uohure
QksVks fpidk;sa

ADMISSION FORM
1-

dk;Ze dksM

dksM

uke

/ Code

Name

Programme Code/Name

2-

Mh-Mh- ua-@ pkyku

fnukad@Date

jkf'k@Amount

cSd
a dk uke@Name of the Bank

Paste self-attested
recent passport size
photograph

D.D. No. / Challan

34-

o"kZ@Year

tuojh

tqykbZ

Jan.

July

l=@Session

{ks=h; dsU

dksM@ Code

vkosnd lEcfU/kr dkWye esa ? dk fpUg yxk;sAa

uke@ Name

Regional Centre

5-

v/;;u dsU

Applicant should put a ( ?) symbol in the relevant column

dksM@Code

uke@ Name

Study Centre

vkosnd dk uke vaxzsth esa

Name of Applicant in English

6-

vkosnd dk uke fgUnh esa

Name of Applicant in Hindi

7-

firk dk uke vaxzsth esa

Father's Name in English

8-

ekrk dk uke vaxzsth esa

Mother's Name in English

9-

irk@Address
PIN CODE

e-mailAddress

10-

Phone (with area code) /Mobile

Complete the following / iw.kZ fooj.k djsa%&

ikB~;e dksM
Course Code
i
ii
iii
iv
v
vi
vii
vii
ix
x
xi
xii
xiii
xiv

-----------------------------------------------------------------------------------------------------------------------------------------------------------

11-

tUe frfFk

Name of Course

LdkWyj ua-

Js;kad

foojf.kdk ls ns[kdj Hkjsa

---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Credit
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

izek.k i= layXu djsa

/ Date of Birth
Date

12-

13- ijh{kk dk ek/;e

ikB~;e dk uke

Month

Year

/ Scholar No.

;fn iwoZ esa o-e-[kq-fo- esa ukekafdr gSA

(If already registered in VMOU)

Medium of Examination

1- vaxzsth English
2- fgUnh Hindi
14fyax@Sex
1iq:"k Male
2efgyk Female
151234-

Js.kh / Category
vtk SC
vttk ST
vkschlh OBC
vU; Others

1612-

{ks=@ Region
'kgjh Urban
xzkeh.k Rural

17- ukxfjdrk @ Nationality

1Hkkjrh; Indian
2vU; Others

18- fodykax / Handicapped

19- /keZ / Religion _________________
20- vU; / Others
1 - HkwriwoZ lSfud Ex-Army
2 - d'ehjh foLFkkfir

Vardhaman Mahaveer Open University Employee / Wards

Kashmiri Migrant

21123424-

lkekftd fLFkfr / Social

fookfgr/Married
vfookfgr@Unmarried
fo/kok/Widow
ifjR;Drk/Divorcee

Status

lacaf/kr mPp f'k{kk @

mkh.kZ ijh{kk

22- jkstxkj fLFkfr Employment Status

1 - jkstxkj / Employed
2 - csjkstxkj / Unemployed
3 - o/kZeku egkohj [kqyk fo-fo- ds deZpkjh / deZpkjh ds iq=@iq=h@vkfJr

Examination

Passed

23- ch-,- ds fo|kFkhZ rhu ,sfPNd fo"k; HkjsaA ch-,l-lh- ds fo|kFkhZ fufnZS"V fo"k; lewgksa esa ls fdlh
,d lewg dk p;u dj HkjsaA foojf.kdk ns[ksa
Students are required to fill in three elective (optional) subjects. B.Sc. students are required to
select any one of the elective (optional) subject group (see prospectus)
1.______________________________________________________________________________
2.______________________________________________________________________________
3.______________________________________________________________________________

Relevant Highest Qualification

cksMZ@fo'ofo|ky; mkh.kZ gksus dk o"kZ Js.kh@izfr'kr

fo"k;

vuq H ko

Board/University

Subject

Experience

Year of Passing Div./Percentage

vkosnd }kjk ?kks"k.kk

eSa ?kks"k.kk djrk gw fd eSaus bl dk;Ze dh ;ksX;rk dks HkyhHkkfr i<+ ,oa le> fy;k gSA izos'k ds le; eSaus okafNr U;wure ;ksX;rk iw.kZ dj yh gS ,oa mlds
izek.k Lo:i vko';d lwpuk layXu dj nh gSA ;fn esjs }kjk izLrqr lwpuk xyr ikbZ xbZ rks fo'ofo|ky; fdlh Hkh le; esjk izos'k fujLr dj ldrk gSA
,slh fLFkfr esa fo'ofo|ky; dks nh xbZ 'kqYd dh jkf'k dks okfil ekxus dk eq>s dksbZ vf/kdkj ugha gSA
Declaration by the Applicant
I hereby declare that I have read and understood the conditions of eligibility of the programme in which I seek admission. I fulfil minimum eligibility criteria and have
provided necessary information in this regard. In the event of any information being found incorrect or misleading, my candidature shall be liable to be cancelled
by the University at any time and I shall not be entitled for refund of fee, paid by me to the University.

fnukad / Date
vkosnd ds gLrk{kj
LFkku @ Place
Signature of the Applicant
vkosnd lacfa /kr {ks=h; dsU ij Hkjk gqvk izo's k vkosnu i= ,oa ijh{kk vkosnu i= okafNr i=ksa dh lR;kfir Nk;k izfr;ksa ,oa Qhl dh
izFke fdLr ds Mh-Mh-@pkyku dh izfr lfgr lacfa /kr {ks=h; dsU ij tek djk;sAa (Applicant should deposit the filled in admission
form alongwith attested copies of desired documents and DD/Copy of Challan of first instalment of fee).

lacaf/kr dkWye esa ? fVd djsaA

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Tick ? the relevant boxes

Photograph and Sign over it / QksVks e; gLrk{kj

Demand Draft/Challan for programme fee with Name & Form No. overleaf

Qhl gsrq fMek.M MkV@pkyku ds ihNs viuk uke ,oa QkeZ uEcj fy[kdj tek djk;sa
Attched Certificates and Marksheets of 10 (10+2)/U.G./P.G. / ;ksX;rk izek.k i=
Age Certificate / vk;q izek.k i=
Experience Certificate / dk;Z vuqHko izek.k i=
Category Certificate in response to col. no. 15 / Js.kh gsrq izek.k i= dkWye la- 15 ds lac/a k esa
Physically Handicapped Certificate / fodykaxrk izek.k i=
Widow/Divorcee Certificate / fo/kok@ifjR;Drk izek.k i=
Ex-Army Service / HkwriwoZ lSfud
Examination Form / ijh{kk vkosnu i=
For Office Use Only

QkeZ dh tkp dh xbZ rFkk izos'k gsrq ;ksX;@v;ksX; ik;k x;kA

lacfa /kr fyfid ds gLrk{kj
tkpdrkZ ds gLrk{kj
Signature of the Concerned Clerk

fnukad@Date :

Signature
Checked by

funs'kd {ks=h; dsU

lhy ,oa gLrk{kj
Director Regional Centre
Signature with Seal

INSTRUCTIONS
1.

This Card Should be produced on demand at the

study Centre and Examination Centre or any
other Establishment of VMOU to use its facilities .

2.

The facilities would be available only relatin g to the course

3.

Duplicate identity Card will be issued by the

or courses for which the student is actually registered.

Director, Regional Centre on payment of Rs.20/by
way of Demand Draft/Challan only in favour of VMOU
payable at the city where Regional Centre is located.
4.

VARDHAMAN MAHAVEER
OPEN UNIVERSITY , KOTA

Loss of identity Card is to be reported immediately to the

STUDENT CARD

nearest Police Station.

5.

Identity Card is to be submitted to the issuing

authority after completion of the said programme.

(FOR USE OF VMOU FACILITIES ONLY)

Vardhaman Mahaveer Open University ,Kota

ACKNOWLEDGMENT CARD
Dear Student,
Thank you for joining VMOU Programme . We acknowledge the receipt of your application form. Please
mention Scholar Number and name of programme applied for in all your future correspondence with the
University
For Office Use Only
To be filled in by the student .
Programmme Applied for : -------------------------DD/Challan No

: --------------------------

DD/Challan Date

: --------------------------

Amount

: --------------------------

DD Drawn on

: --------------------------

Your Scholar Number is

Scholar No. ----------------------------------------------PASTE

Name of the Programme----------------------------------Name------------------------------------------------------

LATEST PHOTOGRAPH TO
BE PASTED WHICH WILL
BE
ATTESTED BY
UNIVERSITYOFFICE

Father's/Husband's Name--------------------------------------------------------------------------------------------Address (in Capital Letters)-----------------------------------------------------------------------------------------------------------------------------------------------------Pin Code--------------------

ATTESTED BY
DIRECTOR,REGIONAL CENTRE --------------------VARDHAMAN MAHAVEER OPEN UNIVERSITY,
KOTA

Full Signature of the Candidate-----------------------------

Please mention your postal address at the space given below

STAMP

To
------------------------------------------------------------------------------------------------------------------------------------From:
The Director
Regional Centre
Vardhaman Mahaveer Open University
---------------------------

----------------------------------------------------------------------------------------PIN :