ಕರ ನ ಟಕ ಸರ ನ ರ GOVERNMENT OF KARNATAKA PÀ ÁðlPÀ gádå UÁæ«ÄÃuÁ üªàè Þ ªÀÄvÀÄÛ ÀAZÁAiÀÄvï gáeï «±Àé«zÁå AiÀÄ, UÀzÀUÀ KARNATAKA STATE RURAL DEVELOPMENT AND PANCHAYAT RAJ UNIVERSITY, GADAG Cfð ÀASÉå Application No. 2018-19 Éà Á À ÁßvÀPÉÆÃvÀÛgÀ PÉÆà ÀÄðUÀ½UÉ Cfð APPLICATION FOR POST GRADUATE COURSES DURING 2018-19 ªÀÄä J Áè ÉÃrPÉUÀ½UÉ Àæ ÀPÀÛ ÀæªÀiÁt ÀvÀæUÀ¼À ÉgÀ¼ÀZÀÄÑ ÀæwUÀ¼À ÀÄß UÀwÛ ÀĪÀÅzÀÄ PHOTO COPIES of relevant certificates should be submitted for all your claims J Áè CAPÀtUÀ¼À ÀÄß vàäa ÉÃPÀÄ. ÀA AzsÀ ÀqÀzÀ CAPÀtUÀ½UÉ NA JAzÀÄ sàwð ªÀiÁqÀĪÀÅzÀÄ, C ÀÇtðªÁzÀ CfðAiÀÄ ÀÄß wgà ÀÌj À ÁUÀĪÀÅzÀÄ All fields should be filled. Fields not applicable should be written as NA Incomplete Application is liable to be rejected. Candidates shall submit separate applications and separate fees for each of the course applied for 1. êÀÅ AiÀiÁªÀ PÉÆà ïðué ÀæªÉñÀ AiÀÄ ÀÄwÛÃj? To which course do you seek admission? êÀÅ E ÁߪÀÅzÁzÀgÀÆ PÉÆà ïð/péæã ïðuà½ué ÀæªÉñÀPÉÌ Cfð ºÁQ ÝÃgÁ? ºÁUÁzÀgÉà ªÀÄä DzÀåvÉ0iÀÄÄ K ÀÄ? Have you applied for any other course/courses? if so, what is your order of preference? First preference Second preference Third preference Fourth preference Fifth preference Sixth preference Seventh preference Eighth preference 2. Cfð ±ÀÄ Ì ÁªÀw¹zÀ «ªÀgÀ Application fee paid details ±ÀÄ Ì Fee (in Rupees) ÁAPÀ Date ÁåAPï ºÉ ÀgÀÄ ªÀÄvÀÄÛ ±ÁSÉ Name of the Bank &Branch r.r. ÀASÉå/D À ÉÊ ï ÁªÀw «ªÀgÀ D.D.Number/Online Payment Details 3. C sàåyðaiàä ºÉ ÀgÀÄ Candidate s Name ºÉ ÀgÀÄ Name À» Signature 4. gá ÖçÃAiÀÄvÉ Nationality : ságàwãaiàä Indian 5. AUÀ Gender: ÀÅ: Male ¹Ûçà :Female ªÀÄAUÀ¼ÀªÀÄÄT / Transgender D D M M Y Y Y Y 6. ºÀÄnÖzÀ ÁAPÀ Date of Birth ªÀAiÀÄ ÀÄì (1 Éà dä ÉÊ 2017 ÁAPÀPÉÌ) Age (As on 1 st July 2017) Affix recent passport size photograph Note: This application may be downloaded from the University website www.ksrdpru.in and sent to the Registrar, KSRDPR University, Raitha Bhavana, General Cariyappa Circle, Gadag 582101, Karnataka, with necessary fees and enclosures (for more details see admission notification).
- 2-7. vá ÄAiÀÄ ºÉ ÀgÀÄ PÉ À/ ÉÃªÉ Mother s Name Occupation vàazéaiàä ºÉ ÀgÀÄ Father s Name Or CxÀªÁ ÉÇõÀPÀgÀ ºÉ ÀgÀÄ Guardian s Name 8. ªÀUÀð Category For Karnataka Candidates only Online Scholarship (Post metric) Registration No. (for SC/ST candidates only) 9. Online Scholarship (Post metric) Registration No. (for Cat-I, IIA, IIIA, IIIB & Other Candidates excluding minorities only) PÉ À/ ÉÃªÉ Occupation PÉ À/ ÉÃªÉ Occupation 10. vàazé/vá ÄAiÀÄ ªÁ ðpà ªÀgÀªÀiÁ À Father s / Mother s Annual Income Rs. 11. êÀÅ qàvà À géãsévavà PɼÀVgÀÄ«gÁ? Do you belong to Below Poverty Line Family (BPL) ºËzÀÄ Yes E è No 12. êÀÅ PÀ ÁðlPÀzÀ è K¼ÀÄ ªÀgÀĵÀ «záå sáå À ªÀiÁrgÀÄ«gÁ? Have you studied 7 years in Karnataka? ºËzÀÄ Yes E è No 13. DzsÁgï PÁqïð ÀASÉå Aadhaar Card No. 14. 10 Éà vàgàuàwaiàä ÉÆÃAzÀt ÀASÉå SSLC/CBSE Register No. 15. ÀA ÀQð ÀĪÀ «¼Á À Address for correspondence E-ªÉÄà ï e-mail id ÀUÀgÀ City gádå State ïpéæãqï Pin Code zàægàªátâ Telephone 16. PÁ²äÃjà ªÀ ¹UÀgÉÃ? Are you a Kashmiri migrant? ºËzÀÄ Yes E è No 17. ºÉÊzÀgÁ Ázï PÀ ÁðlPÀzÀ «záåyðaiéäã? Are you a student of Hyderabad-Karnataka? ºËzÀÄ Yes E è No
- 3-18. dªàäää ªÀÄvÀÄÛ PÁ²äÃgÀ «záåyðaiéäã? Are you a student of Jammu & Kashmir State? ºËzÀÄ Yes E è No 19. 1 jazà 10 Éà vàgàuàwaiàäªàgéué UÁæ«ÄÃt ÀæzÉñÀzÀ è C sàå¹¹ ÝÃgÁ? Have you studied in Rural Area upto 10 th Std? ºËzÀÄ Yes E è No 20. 1 jazà 10 Éà vàgàuàwaiàäªàgéué PÀ ÀßqÀ ªÀiÁzsÀåªÀÄzÀ è C sàå¹¹ ÝÃgÁ? Have you studied in Kannada Medium upto 10 th Std? ºËzÀÄ Yes E è No 21. êÀÅ PɼÀPÀAqÀ AiÀiÁªÀÅzÁzÀgÀÆ PÉÆÃmÁzÀrAiÀÄ è ÀæªÉñÀ EaÒ ÀÄ«gÁ? Mention whether you claim any of the following quota? QæÃqÁ Sports ÁA ÀÌöÈwPÀ Cultural J ï¹¹ NCC J ïj ïj ï NSS ÉÊ PÀgÀ ªÀÄPÀ̼ÀÄ Defence êÀÅ «PÀ ZÉÃvÀ ÀgÉ? Differently Abled/Visually Challenged 22. CºÀðvÁ ÀzÀ««ªÀgÀUÀ¼ÀÄ Details of qualifying examination a. ÀzÀ«Degree b. «±Àé«zÁå AiÀÄzÀ ºÉ ÀgÀÄ : Name of the University ºÉÆgÀ gádåzà «±Àé«zÁå AiÀÄ: Other University Outside Karnataka c. véãuàðqéaiàiázà ªÀµÀð Year of passing d. ÉÆÃAzÀt ÀASÉå Register No. e. zàeéð Class I/II/III f. UÀjµÀ CAPÀUÀ¼ÀÄ Max. Marks g. ÀqÉ gàäªà CAPÀUÀ¼ÀÄ Marks obtained ÀzÀ«AiÀÄ è ÀqÉ gàäªà CAPÀUÀ¼ÀÄ Marks in Degree sáµé Languages UÀjµÀ CAPÀUÀ¼ÀÄ Max. Marks ÀqÉzÀ CAPÀUÀ¼ÀÄ Marks scored LaÒPÀ Optionals UÀjµÀ CAPÀUÀ¼ÀÄ Max.Marks ÀqÉzÀ CAPÀUÀ¼ÀÄ Marks scored
- 4-23. êÀÅ AiÀiÁªÀÅzÁzÀgÀÆ ÁßvÀPÉÆÃvÀÛgÀ ÀzÀ«CxÀªÁ EAd ÃAiÀÄjAUï, PÀÈ ªÀÄvÀÄÛ EvÀgÀ ªÀÈwÛ ÀgÀ ÀzÀ«ÀqÉ ÝÃgÁ? Have you passed any Post Graduate Degree or Engineering, Agriculture and Professional? ºËzÀÄ Yes E è No 1.vÉÃUÀðqÉAiÀiÁzÀ ªÀµÀð Year of passing a. ÉÆÃAzÀt ÀASÉå Register No. b. zàeéð Class I/II/III c. UÀjµÀ CAPÀUÀ¼ÀÄ Max. Marks d. ÀqÉ gàäªà CAPÀUÀ¼ÀÄ Marks obtained 24. véãuàðqéaiàiázà EvÀgÉ ÀjÃPÉëUÀ¼ÀÄ Other examinations passed 1 2 3 4 25. ÁæAiÉÆÃfvÀ C sàåyðaiàiávzàýgé- ÀA ÉÜAiÀÄ ºÉ ÀgÀÄ ºÁUÀÆ ÀÆPÀÛ zár É ÀvÀæªÀ ÀÄß UÀwÛ¹ (Dgï.r..Dgï /EvÀgÉ E ÁSÉ) CfðUÀ¼À ÀÄß ÀªÀÄÄäaÑvÀ ªÀiÁUÀðzÀ ªÀÄÄSÁAvÀgÀ À è ÀĪÀÅzÀÄ. If you are a Sponsored candidate mention Organization s Name & enclose a copy of the certificate (RDPR / Other Depts) Application should be submitted through proper channel. 26. «±Àé«zÁå AiÀÄzÀ ÀæªÉñÀ ÀqÉzÀgÉ «záåyð AiÀÄzÀ Ë sàå AiÀÄ ÀÄ«gÁ? Do you need Hostel facility, if you are selected for the Course in the University ºËzÀÄ Yes E è No 27. EvÀgÉ ªÀiÁ»w Any other information you would like to furnish 28. «záåyð ÄAzÀ zàèrüãpàj À àlö MlÄÖ UÀwÛ À ÁzÀ ÀæwUÀ¼ÀÄ Total Number of enclosures attested by the Candidate C sàåyðaiàä WÉÆõÀuÉ Declaration by the Candidate Á ÀÄ ªÉÄÃ É w½¹gàäªà J Áè ªÀiÁ»wUÀ¼ÀÄ ÀvÀåªÁVgÀÄvÀÛzÉ JAzÀÄ WÉÆà ÀÄvÉÛÃ É ªÀÄvÀÄÛ AiÀiÁªÀÅzÉà ªÀiÁ»wAiÀÄ ÀÄß CqÀV¹gÀĪÀÅ è. Á ÀÄ và ÀÅöà ªÀiÁ»w ÃrzÀÝ è, PÀ.gÁ.UÁæ.C. ÀA.gÁ. «±Àé«zÁå AiÀiÁªÀÅ, À Àß «gàäzàþ PÀæªÀÄPÉÊUÉƼÀî ºÀÄzÁVgÀÄvÀÛzÉ ºÁUÀÆ À Àß ÀæªÉñÀªÀ ÀÄß ÀºÀ gàzàäý Àr À ºÀÄzÁVzÉ. I hereby declare that the above information furnished by me is true. I have not suppressed any information. K.S.R.D.P.R University can initiate action against me, if I have furnished any wrong information and also my admission may be cancelled. ÁAPÀ Date : ÀܼÀ Place : C sàåyðaiàä À» Signature of the Applicant Application No.
- 5 - For Office use only Supernumerary weightage Details Weightage Awardees Name Signature Date Sports Cultural NCC NSS Defence Physically Challenged Details to be filled by the applicant and to be verified by the Office Sl No. Particulars 1. Whether photocopy of the SSLC Marks card enclosed Yes / No Register No. 2. Whether photocopy of the PUC Marks card enclosed Yes / No Register No. 3. Aggregate Qualifying exam Register No. % Cognate Subject Cognate Subject % 4. Whether photocopy of the Caste Certificate enclosed Yes / No If yes, which category you belong to 5. Whether photocopy of the Income Certificate enclosed 6. Whether photocopy of Aadhaar card enclosed 7. Whether registered for scholarship in Social Welfare Department? (for SC/ST applicants only) 8. Whether applied for scholarship in Backward classes welfare Department previous year? 9. Whether the candidate applied for any supernumerary quota (Sl.17 to 20) Yes / No If yes, parent s/guardian s annual income Yes / No If yes, Aadhaar Card No : If yes, mention Registration No : Yes / No If yes, mention Registration No : Yes / No Signature of the verifying official Seal & Signature of the Registrar / Head of the School UNIVERSITY S COPY
- 6 - GOVERNMENT OF KARNATAKA KARNATAKA STATE RURAL DEVELOPMENT AND PANCHAYAT RAJ UNIVERSITY, GADAG Post Graduate Admission 2018-19 ACKNOWLEDGEMENT 1. Candidate s Name :.... 2. Application No. :.. 3. Course :.. 4. Category :.. 5. Date of submission :.. Collecting Official s Name CANDIDATE S COPY GOVERNMENT OF KARNATAKA KARNATAKA STATE RURAL DEVELOPMENT AND PANCHAYAT RAJ UNIVERSITY, GADAG Post Graduate Admission 2018-19 ACKNOWLEDGEMENT 1. Candidate s Name :.... 2. Application No. :.. 3. Course :.. 4. Category :.. 5. Date of submission :.. Collecting Official s Name