AYODHYA CHARITABLE TRUST

 51/2 Vikas Nagar, Near SRPF Gate No - 2, Wanwadi, Pune 411040

Phone No. : 020 26855460/26856141, Fax No. : 020 26856809

Email : ayodhyatrust@gmail.com

 
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AYODHYA CHARITABLE TRUST’s

COLLEGE OF SPECIAL EDUCATION, PUNE

 

Application for admission to BACHELOR of educaton in special education for the academic year 2017-18

[B.ED. SE-DE (dISTANCE EDUCATION) ]

Application Number : _____________________

 

 

 

 

Please fill up all details in CAPITAL LETTERS:

 

1. Name : _______________________________________________________________

 

2. Father’s Name : _____________________________________________________

 

3. Gender (Male / Female) : Male Female

 

4.. Birth date : Age : (years)

 

5. Nationality : Indian / Others (Pl. specify) ____________________

 

6. Community                 :                                SC ST OBC PH General

(Enclose Xerox copy of the certificate by way of proof Original should not be enclosed)

 

7. Permanent Address ___________________________________________________________

 

_________________________________________________________________

(nearest land mark) Pin Code :

 

Tel. (Resi) Mobile No.:

 

 

8. Educational Qualification :

 

Sr.no.

Exam Passed

Name of the Board / University

Year of Passing

% of marks

Subjects

Division / Grade

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9. List of enclosures:

i) Matric upto Degree / Marksheet (Photo copies only)

ii) Caste certificate (Photo copies only)

iii) Two Passport size photographs

                iv) Leaving certificate

                v) Experience certificate

 

I hereby declare that I have read and understood the eligibility criteria for admission to a Diploma course. In the event of any information found incorrect or misleading, my admission would be liable to be cancelled by RCI and I shall not be entitled for refund any of the fee paid by me.

 

 

Date:                                                                                                 Signature of the student

 

 

 

                                Signature of Guardian:

 

 


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