College Admission Form

Name of applicant in block letters as in degree certificate*

PrefixFirst NameMiddle InitialLast Name
Permanent Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Address for correspondence*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Aadhar Number*
Email Id*
example@example.com
Place of Birth*
Date of Birth*

DayMonthYear
Mobile Number*
Caste*
Sub caste*
Religion*
Nationality*
Name of the college, where Graduation was done*

Details of EDUCATIONAL QUALIFICATION*

Application Fee Receipt No.
1. I undertake to abide by the rules and regulations stipulated by the Government of Karnataka, Bangalore University and the institution. 2. During the tenure of the course, I am willing to participate in educational tours, sports, games and other healthy practices. 3. I declare that all the information furnished in the application form are true.
Place*
Date*

DayMonthYear
Signature of Applicant*

Clear
I agree to pay all the prescribed fees and own the responsibility for the conduct and discipline of my son / daughter. I am aware that the student who does not adhere to rules and regulations will be subject to disciplinary action.
Place*
Date*

DayMonthYear
Signature of Father / Husband*

Clear
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FOR OFFICE USE ONLY

Office note regarding fees paid:

Payment Mode:

Receipt No:

Date :

Manager
Should be Empty: