APPLICATION FORM FOR ADMISSION

DISTANCE EDUCATION
ENROLLMENT NO.                                                                      SESSION          
YEAR OF ADMISSION                                                                      MEDIUM      
YEAR OF PROGRAMME
NAME OF COURSE
DURATION FROM To (in case of certificate & diploma course)
Compulsary Subject        
ORIGNAL SUBJECT                    
NAME OF APPLICANT FULL NAME           MIDDLE NAME        LAST NAME
IN ENGLISH        
IN HINDI        
MOTHER'S NAME:
IN ENGLISH
IN HINDI
FATHER'S NAME:
IN ENGLISH
IN HINDI
PERMANENT ADDRESS:
                         Street         City/Address             Post      
                         District       State                PIN Code      
                       STD Code    Phone             Mobile              E-Mail      
CORRESPONDING ADDRESS:
                         Street         City/Address             Post      
                         District           State             PIN Code      
                       STD Code       Phone           Mobile           E-Mail      
SEX                     CATEGORY          
DATE OF BIRTH                                                           NATIONALITY      
DOMICILE                                                           RESIDENCE        
EXAMINATION CENTER(For Distance Education)
AADHAR CARD NO.
EDUCATION QUALIFICATION:
EXAMINATION BOARD/UNIVERSITY YEAR OF PASSING % OF MARKS OR GRADE SUBJECTS
Secondary/ Matriculation
Sr. Sec / Intermediate / 10+2
Under Graduate
PG Graduate
Any Others
Whether employee or dpendent of the employee of JVBI/JVB(if yes, attach certificate)