New APPlication form -16

Bản ghi

1 PÜ ÝìoPÜ ÓÜPÝìÃÜ Government of Karnataka PÝÇæàgá ÎPÜÒ CÇÝTæ Department of Collegiate Education ÊÜá¾ GÇÝÉ æàwpæwüúwæ ±ÜÅÓÜPÜ ±ÜÅÊÜÞ ±ÜñÜÅWÜÙÜ æãüùüaüác ±ÜÅ WÜÙÜ Üá ÆWÜ ÓÜáÊÜâ Üá Photo-copies of relevant certificates should be submitted for all your claims GÇÝÉ AíPÜ WÜÙÜ Üá ñüáíÿ æàpüá. ÓÜíŸí«Ü±ÜvÜ Ü AíPÜ WÜÚWæ N.A. Gí Üá»Ü ì ÊÜÞvÜáÊÜâ Üá, All the fields should be filled. Fields not applicable should be written as N.A. Incomplete application is liable to be rejected 1. àêüâ ÞÊÜ PæãàÓ ì/pæãàó ìwüúwæ ±ÜÅÊæàÍÜ Ÿ áóüá àä? To which course do you seek admission? Affix recent passport size photograph & æà ÓÝÈ Ü ÓÝ ñüpæãàñü ÃÜ ±ÜÅÊæàÍÜPæR Aiì ÝÃÜí APPLICATION TO POST GRADUATE COURSES FOR THE ACADEMIC YEAR 20 - àêüâ C Ý ÊÜâ Ý ÜÃÜã PæãàÓ ì/pæãàó ìwüúwæ ±ÜÅÊæàÍÜPæR Aiì ÖÝQ ªàÃÝ? ÖÝWÝ ÜÃæà ÊÜá¾ B ÜÂñæ áá H Üá? Have you applied for any other course/courses? if so, what is your order of preference? Êæã ÜÆ B ÜÂñæ /First preference 3. A»Ü ì á ÖæÓÜÃÜá Candidate s Name ÖæÓÜÃÜá Name C Ò áç Initial Ì à á B ÜÂñæ /Second preference 2. Aiì ÍÜáÆR ±ÝÊÜ Ô Ü ËÊÜÃÜ Application fee paid details. (D.D.to be drown in the name of Principal, Smt. VHD Central Institute of Home Science, Bangalore-01) ÍÜáÆR Fee (in Rupees) ÝíPÜ Date ÍÝTæ Branch w.w. Üí./ÃÜÔà ÓÜíTæ D.D. No./Receipt No. 4. ÃÝÑóà áñæ Nationality :»ÝÃÜ à á Indian Ë æàî Foreigner D D M M Y Y Y Y D D M M Y Y Y Y 5. ÖÜáqr Ü ÝíPÜ Date of Birth: ÊÜ áóüáõ(1 æà gáçæç 2016 ÝíPÜPæR) Age (As on 1st July 2016)

2 6. ñýàá á ÖæÓÜÃÜá Mother s Name ñüí æ á ÖæÓÜÃÜá Father s Name A ÜÊÝ Or ±æäàðüpüãü ÖæÓÜÃÜá Guardian s Name ±æäàðüpüäwæ àêüâ JŸºÙæ ÊÜáWÜÙæà BX ܪÈÉ, A àpüêñü ±ÜÅÊÜÞ ±ÜñÜÅÊÜ Üá ÆWÜ ÓÜ æàpüá Are you the only Girl child of your parents? If yes, enclose an affidavit from competent authority 8. ÊÜWÜì Category : Online Scholarship (post matric) Registration No. (for SC/ST candidates only) 9. ñüí æ/ñýàá á ÊÝÑìPÜ ÊÜÃÜÊÜÞ Ü Father s/mother s Annual Income: 10. àêüâ ŸvÜñÜ Ü ÃæàTæXíñÜ PæÙÜXÃÜáËÃÝ? Do you belong to Below Poverty Line Family (BPL) 11. àêüâ PÜ ÝìoPÜ ÜÈÉ HÙÜá ÊÜÐÜì Ë Ý»ÝÂÓÜ ÊÜÞwÃÜáËÃÝ? Have you studied 7 years in Karnataka? æà ñüãüwü á æãàí Ü~ ÓÜíTæ SSLC Register No. 13. ÊÜáñÜ ÝÃÜÃÜ ÓÜíTæ Voter Card No. Others Rs. 14. ÓÜí±ÜQìÓÜáÊÜ ËÙÝÓÜ Address for correspondence ÜWÜÃÜ City ÃÝg State ² Pæãàv Pin Code ÜãÃÜÊÝ~ Telephone C&ÊæáàÇ id 15. PÝξàÄà ÊÜÆÔWÜÃæà? Are you a Kashmir migrant Äí Ü 10 æà ñüãüwü áêüãæwæ WÝÅËáà ±ÜÅ æàíü ÜÈÉ A»ÜÂÔÔ ªàÃÝ? th Have you studied in Rural area upto 10 Std.? Äí Ü 10 æà ñüãüwü áêüãæwæ PÜ Ü vü ÊÜÞ«ÜÂÊÜá ÜÈÉ A»ÜÂÔÔ ªàÃÝ? th Have you studied in Kannada Medium upto 10 Std.?

3 18. àêüâ PæÙÜPÜívÜ ÞÊÜâ Ý ÜÃÜã PæãàpÝ Üw áèé ±ÜÅÊæàÍÜ CbfÓÜáËÃÝ? Mention whether you claim any of the following quota? QÅàvÝ Sports ÓÝíÓÜ PÜ Cultural G ÔÔ NCC G GÓ GÓ NSS Óæç PÜÃÜ ÊÜáPÜRÙÜá Defence àêüâ ËPÜÆaæàñÜ ÜÃæ? Physically challenged 19. AÖÜìñÝ ±Ü ÜË ËÊÜÃÜWÜÙÜá Details of qualifying examination a. ±Ü ÜË Degree b. 1. æíwüùüããüá ËÍÜÌË ÝÂÆ á Bangalore University 2. PÜ ÝìoPÜ æãùüx Ü CñÜÃæ ËÍÜÌË ÝÂÆ á Other University within Karnataka 3. ÖæãÃÜ ÃÝgÂ Ü ËÍÜÌË ÝÂÆ á Other University from Outside Karnataka c. ñæàwüìvæ Þ Ü ÊÜÐÜì Year of passing d. æãàí Ü~ ÓÜíTæ Register No. e. Ühæì Class-I/II/III f. WÜÄÐÜu AíPÜWÜÙÜá Max. Marks g. ±Üvæ ÃÜáÊÜ AíPÜWÜÙÜá Marks obtained ±Ü ÜË áèé ±ÜÜvæ ÃÜáÊÜ AíPÜWÜÙÜá Marks obtained in Degree»ÝÐæ Languages WÜÄÐÜu AíPÜWÜÙÜá Max. Marks ±Üvæ Ü AíPÜWÜÙÜá Marks scored IbfPÜ Optionals WÜÄÐÜu AíPÜWÜÙÜá Max. Marks ±Üvæ Ü AíPÜWÜÙÜá Marks scored 20. àêüâ ÞÊÜâ Ý ÜÃÜã ÓÝ ñüpæãàñü ÃÜ ±Ü ÜË E ìãýx ªàÃÝ? Have you passed any Post Graduate Degree? 1. æíwüùüããüá ËÍÜÌË ÝÂÆ á Bangalore University 2. PÜ ÝìoPÜ æãùüx Ü CñÜÃæ ËÍÜÌË ÝÂÆ á Other University within Karnataka 3. ÖæãÃÜ ÃÝgÂ Ü ËÍÜÌË ÝÂÆ á Other University from outside Karnataka a. ñæàwüìvæ Þ Ü ÊÜÐÜì Year of passing b. æãàí Ü~ ÓÜíTæ Register No. c. Ühæì Class-I/II/III d. WÜÄÐÜu AíPÜWÜÙÜá Max. Marks e. ±Üvæ ÃÜáÊÜ AíPÜWÜÙÜá Marks obtained

4 21. ñæàwüìvæ Þ Ü CñÜÃæ ±ÜÄàPæÒWÜÙÜá Other examinations passed ±ÝÅÁãàiñÜ A»Ü ì & ÓÜíÓæ á ÖæÓÜÃÜá ÖÝWÜã ÓÜãPÜ ÝSÇæ ±ÜñÜÅÊÜ Üá ÆWÜ Ô If you are a Sponsored candidate - mention Organization s Name and enclose a copy of the certificate 23. PÝÇæài Ü Ë»ÝWÜWÜÙÜÈÉ ±ÜÅÊæàÍÜ ±Üvæ ÜÃæ Ë Ý ì Æ á Ü ÓèƻܠŸ áóüáëãý? Do you need Hostel facility, if you are selected for Post graduate Studies? 24. Ë Ý ì Æ á Ü ÓèƻܠŸ áô ܪÈÉ, ÊÜá¾ ÊÝÓÜÓÜ ÙÜ í Ü æíwüùüãäwæ ÜãÃÜ GÐÜár? If you need Hostel facility, what is the distance to Bangalore from your native place? ÜãÃÜ : Q.Ëáà.WÜÙÜÈÉ Distance : in Kms. 25. CñÜÃæ ÊÜÞ Any other information you would like to furnish 26. Wæhæpæv A PÝÄÀáí Ü Üê{àPÜÄÓÜƳor Joár ÆWÜ ÓÜÇÝ Ü ±ÜÅ WÜÙÜá Total Number of enclosures attested by the Gazetted Officer A»Ü ì á NãàÐÜOæ Declaration by the Candidate Ý Üá ÊæáàÇæ ÚÔÃÜáÊÜ GÇÝÉ ÊÜÞ WÜÙÜá ÓÜñÜÂÊÝXÃÜáñÜ æ Gí Üá NãàÑÓÜáñæ à æ ÊÜáñÜá ÞÊÜâ æà ÊÜÞ á Üá AvÜXÔÃÜáÊÜâ ÆÉ. Ý Üá ñü±üâ³ ÊÜÞ àw ܪÈÉ, PÝÇæài ÜÊÜÃÜá Ü Ü ËÃÜá Üœ PÜÅÊÜá PæçWæãÙÜÛŸÖÜá ÝXÃÜáñÜ æ. I hereby declare that the above information furnished by me is true and I have not hidden any information. College can initiate action against me, if I have furnished any wrong information. ÝíPÜ Date : ÓÜ ÙÜ Place : A»Ü ì á ÓÜ Signature of the Applicant

5 Government of Karnataka Department of Collegiate Education ACKNOWLEDGEMET 1. Candidate s Name : Application No. : Department : Category : Date of Submission :... Collecting Official s Name... Government of Karnataka Department of Collegiate Education NOTICE Students seeking admission to M.Sc. Home Science and M.A. in Sociology courses are requested to bring the following for the admission counseling to be held on...and...august 20...in the Respective Departments, College Campus from a.m. onwards. Documents required: 1. All Original Marks Card 2. Category Certificate 3. Income Certificate 4. Any other relevant Certificate passport size photos