Format - 7
Admission Form: Agriculture Programs: 2014-15
Paste Passport size Photo
(35 mm X 45 mm)
Form No. (for RC)
`ed§Vamd ÀmìhmU _hmamï´> _wŠV {dÚmnrR>
Yashwantrao Chavan Maharashtra Open University
Photo should not exceed
the borders.
Dnyangangotri, Nashik - 422 222, MS, India
Name of Program:
Program Code:
({ejUH«$_mMo Zmd)
({ejUH«$_ g§H$o Vm§H$)
Name of Centre:
Centre Code:
(H¥${f {ejU H|$ÐmMo Zmd)
({ejUH|$Ð g§H$o Vm§H$)
Name of the Bank
Challan No.
Amount in Rs.
Important Instructions for Students ({dÚmÏ`mªgmR>r _hÎdmÀ`m gyMZm)…
1. Read prospectus carefully & use black ink ballpen to fill the form.
2. Fill in all fields in CAPITAL English letters only. (AO© ^aVmZm H°${nQ>b
3. Mark 9 in appropriate box. (`mo½` Ë`m Mm¡H$moZmV 9 Aer IyU H$am)
nmgnmoQ>© gmB©OMm
(35x45 _r._r.) AmH$mamMm
\$moQ>mo {MH$Q>dm.
Bank Transaction No.
(_m{hVrnwpñVH$m dmMyZ àdoe AO© H$mù`m emB©Zo ^am)
B§J«Or Ajam§MmM dmna H$am)
↑ darb Mm¡H$Q>rV H$mù`m emB©Zo
16 Digit PRN (if allotted)
ñdmjar H$am.
16 A§H$s H$m`_ Zm|XUr H«$_m§H$
1. Personal Information Section:
(d¡`pŠVH$ _m{hVr)
Last Name
First Name
(AmS>Zmd)
Father’s/Husband’s Name
(ñdV…Mo Zmd)
Mother’s Name
(d{S>bm§Mo/nVrMo Zmd)
(AmB©Mo Zmd)
Name of the Student (in English)
{dÚmÏ`m©Mo Zmd (_amR>rV)
Date of Birth OÝ_VmarI…
D
D
M M
Social Reservation (gm_m{OH$ AmajU g§dJ©)
Parallel Reservation (g_m§Va
Contact Details:
Country
AmajU àdJ©)
Y
Y
Y
Y
Gender qbJ… Male nwéf
SC
ST
VJ(A)
NT(B)
Women
PAP
PH
FF
Female ñÌr
Mother tongue _mV¥^mfm…
NT(C)
NT(D)
OBC
SBC
Open
DP
g§nH$m©gmR>r nÎmm…
Xoe:
Phone No. ( STD
State amÁ`:
)
District {Oëhm:
Mobile Number:
Email ID:
2. Program & Academic Qualification Section: ({ejUH«$_
Last College Attended
Am{U e¡j{UH$ _m{hVr)… Imbrb VŠË`m_Yrb AmnUmg bmJy Agbobm EH$M aH$mZm ^am.
eodQ>Mo H$m°boO/emim…
Program Code & Name
AmnU àdoemgmR>r {ZdS>bobm {ejUH«$_
C1D: Certificate in Gardening
(_mir à{ejU à_mUnÌ)
T12: Foundation in Agriculture
PIN {nZ
City eha:
Tehsil VmbwH$m:
Year…
Academic Qualification
Amnbr {dÚ_mZ e¡j{UH$ nmÌVm
Std. 10th Pass/Fail (10dr
Std. 12th Pass/Fail
Roll No:
Board/University
~moS>/© {dÚmnrR>
nmg/Zmnmg)
(12dr nmg/Zmnmg)
(H¥${f A{Yð>mZ)
T20: Diploma in Horticulture
(CÚmZ{dÚm nX{dH$m)
T14: Diploma in Agri-Business Management
(H$¥{f-ì`dgm` ì`dñWmnZ nX{dH$m)
P18: Diploma in Agro-Journalism
(H$¥{f-nÌH$m[aVm nX{dH$m)
T15: Diploma in Fruit Production
(\$i~mJm CËnmXZ nX{dH$m)
T16: Diploma in Vegetable Production
(^mOrnmbm CËnmXZ nX{dH$m)
Foundation in Agriculture (YCMOU) (H¥${f
Diploma in Agriculture (SAU) (H¥${f
T19: Bachelor of Science in Agriculture
(H¥${f {dkmZ nXdr)
T18. Bachelor of Science in Horticulture
(CÚmZ{dÚm nXdr)
Diploma in Agriculture (SAU) (H¥${f
OR
A{Yð>mZ)
OR
A{Yð>mZ)
OR
{dÚmnrR> nX{dH$m)
T17: Diploma in Floriculture & Landscaping Foundation in Agriculture (YCMOU) (H¥${f
(\w$beoVr d àm§JUCÚmZ nX{dH$m)
A{Yð>mZ)
{dÚmnrR> nX{dH$m)
Foundation in Agriculture (YCMOU) (H¥${f
Diploma in Agriculture (SAU) (H¥${f
OR
{dÚmnrR> nX{dH$m)
Foundation in Agriculture (YCMOU) (H¥${f
Diploma in Agriculture (SAU) (H¥${f
A{Yð>mZ)
{dÚmnrR> nX{dH$m)
Foundation in Agriculture (YCMOU) (H¥${f
Diploma in Agriculture (SAU) (H¥${f
OR
{dÚmnrR> nX{dH$m)
Foundation in Agriculture (YCMOU) (H¥${f
Diploma in Agriculture (SAU) (H¥${f
A{Yð>mZ)
A{Yð>mZ)
OR
{dÚmnrR> nX{dH$m)
YCMOU CET Pass (_wŠV
{dÚmnrR> nXdr àdoe narjm nmg)
YCMOU CET Pass (_wŠV
{dÚmnrR> nXdr àdoe narjm nmg)
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11
Year of Passing
CÎmrU© df©
Marks (%)
àmá JwU (%)
3. Student's Other Information ({dÚmÏ`m©Mr BVa _m{hVr)
Place of Birth
OÝ_ {R>H$mU…
Domicile of State
Belong to Minority Class: Yes
Blood Group (with Rh)
Student Location
No
Rural J«m_rU
Service
Working Experience (Years)
Urban
Self-employed
H$m_mMm AZw^d (dfo©)…
Christian
Sub-Caste CnOmV…
Sikh
Y_©…
Parsi
Nationality
ehar
Unemployed
(ZmoH$ar)
Caste OmV…
Jain
Religion
Employment Status: Employed
If Employed:
If Yes: Muslim
aŠVJQ>…
a{hdmgmMo joÌ…
a{hdmgr amÁ`…
Nav-Baudh
amï´>r`Ëd…
Tribal Am{Xdmgr
hþÔm/H$m_:
Occupation
Your Annual Inocme(Rs.):
(Y§Xm)
------------------
Profession (ì`dgm`)
Other (BVa)
Marital Status
Unmarried
Married
Divorced
Widowed
Deserted
d¡dm{hH$ pñWVr
A{ddm{hV
{ddm{hV
KQ>ñ\$mo{Q>V
{dYdm/{dYwa
n[aË`ŠVm
YCMOU Employee’s Children
4. Enclosure: gmo~V
Artist Person
Sports Person at College/District/State/National/International level
OmoS>bobr H$mJXnÌo
1.
2.
3.
4.
5.
5. Declaration by the Student: {dÚmÏ`m©Mo
h_rnÌ
_r Ago Z_yX H$aVmo H$s, àdoemg§~§YrMo _m{hVr nwpñVHo$Vrb {Z`_ _r dmMbo AmhoV. àdoeAOm©Vrb ^abobr _m{hVr nyU©nUo Iar AgyZ H$mJXnÌo OmoS>bobr
AmhoV. A§{V_ àdoe _w»`mb`mVyZ {ZpíMV Ho$bm OmB©b, VgoM ^abobo ewëH$ naV qH$dm dJ© Ho$bo OmUma Zmhr, `mMr _bm OmUrd Amho.
{dÚmnrR>mZo KoVbobo àdoem~m~VMo {ZU©` d Ë`mV doimodoir Pmbobo ~Xb _bm ~§YZH$maH$ amhVrb.
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 {R>H$mU… ---------------------------------------------Date {XZm§H$…
Signature of the Student
{dÚmÏ`m©Mr ñdmjar
----------------------------------------------
6. Certificate from Agriculture Education Centre (H¥${f
{ejU H|$ÐmMr {e\$mag)
_r/Amåhr Ago à_m{UV H$aVmo H$s, Cn`©wŠV {dÚmÏ`m©À`m darb {ejUH«$_mÀ`m àdoemgmR>r gmXa Ho$bobr àdoe nmÌVm H$mJXnÌm§Mr VnmgUr Ho$br AgyZ
gXa {dÚmWu Cn`©wŠV {ejUH«$_mÀ`m àdoemgmR>r nmÌ Amho.
We hereby certify that, we have check all the admission eligibility documents of the student & found that he/she is
eligible for the admission of the above program.
22
Place {R>H$mU… ---------------------------------------------Date {XZm§H$…
Sign & Seal of Centre Head/Coordinator
H|$Ðà_wI / H|$Ðg§`moOH$ ñdmjar d {eŠH$m
----------------------------------------------
Note : Student MUST retain photocopy of completely filled in admission form (both pages) for future reference. Information in this form will
be required to activate his/her account on http://ycmou.digitaluniversity.ac portal. nyU© ^aboë`m AOm©Mr (XmoÝhr ~mOy) EH$ àV {dÚmÏ`m©Zo ñdV…H$S>o R>odUo
Amdí`H$ Amho. øm AOm©darb _m{hVrÀ`m AmYmaoM "B©-gw{dYm' AH$mD§$Q> http://ycmou.digitaluniversity.ac da A°pŠQ>ìhoQ> H$aVm `oB©b.
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