UTTARAKHAND OPEN UNIVERSITY
Admission Form for All Programmes 2012-13
Paste your Latest
Passport Size
(4x5cm) Photograph
Duly Attested by
Yourself
(Instructions)
1. Before filling the form please read the instructions given in the Prospectus.
2. Use the black ball pen and Capital Letters for filling this form
3. Do not staple photograph.
4. N.A.
Write N.A. if not applicable.
(Regional Centre Name) (Regional Centre Code)
(ProgrammeApplied for)(Programme Code) (Year/Semester)
4- (Medium) : (English) (Hindi)
5- (BankChallan Particulars)
,(SBI) (BOB) (Journal No.) (Date) / (Amount)
6- (Name)
7- (Father's / Husband's Name)
8- (Mother's Name)
Enrolment No. Form No.
9- (Gender) (Male) (Female)
10- (Date of Birth)
11- (Contact No.) 1.
2.
(DD/MM/YYYY)
12- bZ esy (Email ID)
13- (a) Js.kh (Category) : (GEN) (OBC) (SC)
(b) (Whether Physically Handicapped)
14-
1-
2-
(Study Centre Name) (Study Centre Code)
3-
(Any other)
15- (Religion) : (Hindu) (Muslim) (Christian)
(Sikh) (Jain) (Buddhist)
(Zoroastrian) (Jews) (Others)
16- (Employment Status) : (Unemployed)
(Employed) (UOU Employee)
17- (Marital Status) : (Married) (Unmarried)
Summer Winter
12
18- (CompleteAddress for Correspondence)
19- (Permanent Address)
20- (Academic Qualification)
(Name of
Examination)
(Year of
Passing)
(Name of Board/
University)
(Aggregate
Percentage)
(Division)
(Main Subjects)
21- (Year of Qualifying Bachelor's Preparatory Programme)
(Name of University) (Name of the Programme)
22- Particulars of the Present Programme applied for (Year/Semester-Which ever applicable)
l0
(Sl.No.)
(Course Code)
(Course Title)
Year / Semester
(WhicheverApplicable)
Pin Code
Pin Code
23-
Whether you are expelled / restricted from any educational institute or convicted by a court of law or if
any case is pending against you in a court of Law ?
gk¡ (Yes) ugha (No)
If yes, give details -
For Management Programmes Only
To be compulsorily filled by learner
24- Year & Month of Qualifying M.B.A Entrance Test
...............................................................................
25- MAT/CAT Score (if candidate have not attempted entrance test of UOU)
............................................................
26- Year and Month of qualifying MAT/CAT Score (Attach a copy of result card)
...............................................
27- Year of qualifying BCPP (for non 10+2 applying for BBA) (Attach a copy of certificate issued)
...............................................................................................................................................................................................
28- Total Number of Years of Teaching / Supervisory / Managerial / Professional Experience
..................................................................
29- Organization / Institution served or owned
30- Area of experience : (HR, MM, MF or any other, specify)
................................................................................................................................................................................................
...............................................................................................................................................................................................
Declaration by the Applicant

1) " I hereby declare that the particulars stated in this application form are true to the best of my knowledge and
belief. I have read the prospectus and the admission/ eligibility requirements as laid down by the University and
I shall abide by them. In the event of suppression or distortion of any fact like date of birth, nationality, category and
qualifications etc. in my application, my admission will stand cancelled at any point of time. In case my admission
is cancelled by the University due to any reason, I shall have no claim for refund of fee paid by me.
2) I hereby declare that I have attached all the required documents with this form.
3) Further, I declare that I shall submit myself to the disciplinary jurisdiction of the Coordinator of the study
centre, the Vice Chancellor and other authorities of the University who may be vested with the power to
exercise discipline under the Act, the statutes, the Ordinances framed by the University, in this regard.
These authorities have the right to take necessary disciplinary action.
4) I agree to abide by the rules and regulations.
Place -
Date - Signature of the Applicant
(For Study Centre Use)
(Forwarding Certificate)

"I hereby certify that Mr./ Ms/ Mrs./ Dr. ........................................son/ daughter/ wife of ..............................................
enrolled for this study centre. He / She has been found eligible to be admitted in the .........................................programme
after fulfilling all the conditions laid down in the information brochure/prospectus
Signature
Study Centre & Coordinator
(3) (Organisation)
Work
experience (in years)
/(Name of Position Held)