Admission Form: Agriculture Programs: 2013-14
Format - 7

Yashwantrao Chavan Maharashtra Open University
Dnyangangotri, Nashik - 422 222, MS, India
Form No. (for RC)
Name of Program: Program Code:
Name of Centre: Centre Code:
Name of the Bank Challan No. Amount in Rs. Bank Transaction No.
Important Instructions for Students …
1. Read prospectus carefully & use black ink ballpen to fill the form.
2. Fill in all fields in CAPITAL English letters only.
3. Mark ! in appropriate box.
16 Digit PRN (if allotted)
1. Personal Information Section:
Last Name First Name Father’s/Husband’s Name Mother’s Name
Name of the Student (in English)
Date of Birth D D M M Y Y Y Y Gender Male Female Mother tongue
Social Reservation SC ST VJ(A) NT(B) NT(C) NT(D) OBC Open
Contact Details:
PIN
Country : State : District : Tehsil : City :
Phone No. ( STD ) Mobile Number: Email ID:
2. Program & Academic Qualification Section:
Last College Attended Year… Roll No:
Program Code & Name Academic Qualification Board/University Year of Passing Marks (%)
Std. 10th Pass/Fail (10dr nmg/Zmnmg)
Std. 12th Pass/Fail (12dr nmg/Zmnmg)
Foundation in Agriculture (YCMOU) OR
Diploma in Agriculture (SAU)
Foundation in Agriculture (YCMOU)) OR
Diploma in Agriculture (SAU)
Foundation in Agriculture (YCMOU) OR
Diploma in Agriculture (SAU)
Foundation in Agriculture (YCMOU) OR
Diploma in Agriculture (SAU)
Foundation in Agriculture (YCMOU) OR
Diploma in Agriculture (SAU)
Foundation in Agriculture (YCMOU) OR
Diploma in Agriculture (SAU)
YCMOU CET Pass
YCMOU CET Pass
Paste Passport size Photo
(35 mm X 45 mm)
Photo should not exceed
the borders.

C1D: Certificate in Gardening
T12: Foundation in Agriculture
T20: Diploma in Horticulture
T14: Diploma in Agri-Business Management
P18: Diploma in Agro-Journalism
T15: Diploma in Fruit Production
T16: Diploma in Vegetable Production
T17: Diploma in Floriculture & Landscaping
T19: Bachelor of Science in Agriculture
T18. Bachelor of Science in Horticulture
22
(2)
3. Student's Other Information
Place of Birth Domicile of State a
Belong to Minority Class: Yes No If Yes: Muslim Jain Christian Sikh Parsi Nav-Baudh
Blood Group (with Rh)… Religion Y_©… Nationality
Student Location a Urban Tribal
Employment Status: Employed Unemployed Occupation : Your Annual Inocme(Rs.):
If Employed: Service (ZmoH$ar) Self-employed (Y§Xm)
Working Experience (Years)… ------------------ Profession Other
Marital Status Unmarried Married Divorced Widowed Deserted
YCMOU Employee’s Children Artist Person Sports Person at College/District/State/National/International level
4. Enclosure:
1.
2.
3.
4.
5.
5. Declaration by the Student:
I hereby declare that, I have read the rules related to admission as given in the prospectus; and that the information furnished by me is true and complete to the best of my knowledge. I am aware that my admission will be finalized by the University headquarters and that the admission fee will not be returned or transferred to next year.
Place ---------------------------------------------- Signature of the Student
Date ----------------------------------------------
6. Certificate from Agriculture Education Centre
We hereby certify that, we have check all the admission eligibility documents of the student & found that he/she is eligible for the admission of the above program.
Place ---------------------------------------------- Sign & Seal of Centre Head/Coordinator
Date ----------------------------------------------
Note : Student MUST retain photocopy of completely filled in admission form (both pages) for future reference. Information in this form will be required to activate his/her account on http://ycmou.digitaluniversity.ac portal. http://ycmou.digitaluniversity.ac.