DRAVIDIAN UNIVERSITY
Srinivasavanam:: Kuppam – 517 426, Chittoor Dist (A.P)
Directorate of Distance Education (DDE)
APPLICATION FORM FOR U.G/P.G REGULAR ADMISSION - 2013-14
Name of the Centre/Code: Reg.No.
1. Name of the Applicant:______________________________________________
(In Block Letters only)
2. Father’s Name:____________________________________________________
3. Name of the Course: Subject:
4. Medium: _______________ Subject Code:
5. Date of Birth:
6. Social Status: Sub-Caste:
7. Gender:
8. Address for Correspondence:____________________________________________________________
_________________________________________________________________________________
Phone/Mobile No : _________________________________ E-mail: ___________________________
9. Educational Qualification:
Examination
Passed
Name
of the
Course
Duration
of the
Course
Name of the Institution
College/University
Year of
Passing Subjects Grade/
Percentage Class
S.Sc/ Equivalent
Intermediate
Degree
Others (specify)
10. Fee Particulars: Bank/Branch____________________________________DD No:__________________
Date:_____________Amount:______________
DECLARATION
I declare that all the information submitted in this application form is correct and complete. I acknowledge that Dravidian University reserves the right to withdraw or cancel a course, in case of adequate / minimum admissions are not enrolled in any course.
I declare further that I had read and understood all contents of this application form and information
Brochure and that I am bound by all their contents for all purposes.
Place:
Date: Signature of the Candidate
SC ST BC OC
Male Female
For Directorate Use
Name of the Course:
Admitted Yes ______________ No______
Register Number: Signature of the Dealing Assistant:
Original Certificates verified by Signature of the Admission Officer
Affix recent
passport size
photo with
Gazetted
Officer’s
attestation.
INSTRUCTIONS TO THE CANDIDATES:
1. Name of the applicant & Father’s name are to be filled in Block letters.
2. All U.G & P.G Courses except the Languages are offered only in English &Telugu Medium.
3. Name of the Course applied must be specified in capital letters.
4. Social status and Gender must be clearly stated.
5. Address for correspondence must be mentioned completely along with the pin code.
6. Educational qualifications should be stated clearly with all particulars. Photo copies of the
certificates of the qualifications have to be enclosed.
7. Refer to the eligibility details before submitting the application form.
8. Fees once paid will not be refundable.
9. 2 Passport size photos (one affix on the application form and one on the identity card).
10. The University reserves the right of cancellation of admission of the candidate if any wrong
information found.
11. Students of one study centre where adequate No. of students are not available would be allotted to other Study Centres Examination to attend their examination.
12. Filled in Applications should be submitted to any one of the Study Centres along with their code
number. For Study centres and its code numbers visit www.dravidian university.ac.in.