INDIRA GANDHI NATIONAL OPEN UNIVERSITY APPLICATION FORM FOR ADMISSION TO COMMUNITY COLLEGE

To be submitted at the concerned community college only (JANUARY / JULY SESSION)

[Strike out the session whichever is not applicable]

1. Programme Code:

2.Enrollment No (For office use only)

3. Community College code 5a. Are you already registered with IGNOU (write the relevant code in the box) A1 Yes 4. Medium Code B2 No (write the level code in the box) A1 English 5b. If yes write the programme code & Enrolment No in boxes below B2 Hindi C3 Others Enrollment No: Programme Code: 6. Date of Birth 7. Nationality A1 Indian Date Month Year B2 Others 8. Gender 9. Category 10. Territory code (write the relevant box) (Write the relevant code in the box) (Write the relevant code in the A1 GEN B2 SC A1 Urban code in the box) C3 ST D4 OBC B2 Rural A1 Male (In case of OBC student, please also indicate code either) C3 Tribal B2 Female (i) Creamy layer D4A (ii) Non creamy layer D4B 11. Marital Status 12. Religion 13. Whether minority (Write the relevant A1 Hindu D4 Sikh G7 Parsi (Write the relevant code in the box) code in the box) B2 Muslim E5 Jain H8 Jews A1 Yes A1 Married C3 Christian F6 Budhist I9 Others B2 No B2 Unmarried 14. Name of the candidate (Leave one box empty between first name, middle name & sur name) 15. Father’s / Husband’s Name / Mothers Name (Strike out whichever is not applicable) 16a. Wether physically handicapped 16b. If physically handicapped (nature of disability) 17. Employment Status: (Write the relevant code in the box) (Write the relevant code in the box) (Write the relevant code in the box) 1. Yes 2. No 1. Hearing Impairment 4. Reading Disability 1. Unemployed 2. Locomotors 5. Any other 2. IGNOU Employee 3. Visual Impairment Please Specify: 3. Employed

Application Number

Signature of Candidate

PHOTOGRAPH

Affix your latest passport size

photograph 4cm * 5 cm duly

18. Relevant qualifications which make you eligible for the programme (a) Qualification Code (b) main subjects (c) Year of passing (d) Division (e) % of marks (f) Board Code A1 Below 10th B2 10th Class (last 2 digits only) (01,02,03 or (Do not (Whenever C3 10+2 04 for pass) use decimals) required) 20. Amount DD/Challan/Cheque No: DD/Challan/Cheque Date: 21. Bank name: In case of DD/Cheque 22. Address for correspondence (Do not give Post Box No,Leave a blank between each unit of address House No, Street Name, PO etc) City District State Pin Code 23. STD Code Telephone No 24. Fax no (if any) with STD Code 25. Mobile Number (if any) 26. E-mail address / ID (if any)

Declaration by Applicant

I hereby declare that I have read and understood the conditions of eligibility of for the programme for which I seek admission. I fulfill the minimum eligibility criteria and I have provided necessary information in this regard. In the event of any information being found incorrect or misleading, my candidature shall be liable to cancellation by the Community College at any time and I shall not be entitled to refund of any fee paid by me to the Community College. Further, I have carefully studied the rules as printed in the Prospectus and I accept them and shall not raise any dispute in future over the same rules.

Date:

Checklist Tick the relevant boxes Affix photograph and enclose the following attested copies.

  (i) Demand Draft/Challan Form for program fee.

(ii) Certificate in support of your educational qualification(s).

(iii) Category Certificate for SC/ST/Non-creamy Layer of OBC/PH/Kashmiri Migrant/War Widow candidates wherever required

(IV) Student Card duly filled in along with photograph

 

Signature of candidate

CATEGORY CERTIFICATE (I)

(i) SC/ST Candidates

This is to certify that Mr. / Ms. /Mrs. ____________________________________________________________ son/daughter/wife

Of Shri _____________________________________ of village___________________________________________________

Town__________________ Distt. __________________ State/U.T. ________________________________________belongs

to_____________________Caste which is recognized as scheduled Caste/Scheduled Tribe under the Constitution

(Scheduled Caste Part C States) Order 1951 read with the SC/ST list (Modification Order, 1956)

Mr./Ms./Mrs. _________________________________________________________________________ and her family reside

in Village/Town________________________ District _____________ State/U.T_______________.

(Signature of Tehsildar/Commissioner/District Magistrate)

Place: __________________ Signature: __________________

Date: __________________ Seal/Stamp

CATEGORY CERTIFICATE (II)

(ii) OBC candidates (only non-cremy layer)

This is to certify that Mr. / Ms. /Mrs. _______________________________________________________son/daughter/wife

Of Shri _____________________________________ of village __________________________________________Town

__________________ Distt. __________________ State/U.T. _________________________________________belongs

to______________________________ Caste who are eligible for availing the benefits as per central list of 5 to 13 Cs/OBC

as per Resolution No. 12011/68/93-DDC(C) of ministry of Social Justice & Empowerment as modified from time to time

by that Ministry based on the advice of the National Commission for Backward Classes. (NCBC)Mr./Ms./Mrs.

________________________________________________________________________________ and her family reside

in Village/Town________________________ District _____________ State/U.T_______________ .

(Signature of Tehsildar/Commissioner/District Magistrate)

Place: __________________ Signature: __________________

Date: __________________ Seal/Stamp

 

GUIDELINES FOR FILLING THE APPLICATION FORM

Some Instructions for filling-up of application form are given below:

1. For Programme Code, refer to pages __ to __ of the Prospectus.

2. Leave it blank. Your Community College will allot the Enrolment No.

3. You have to write the code of your Community College which is given in the Prospectus.

4. Please fill the relevant code for medium of instruction in the boxes provided. For example, if

you are choosing Hindi medium then write as shown below.

5. (a) Write relevant code if you already registered with IGNOU.

(b) Write the Enrolment No. and Programme Code if you already registered with IGNOU.

6. Please follow the rule of Date/Month/Year. E.g. 25th June 1983 should be written as:

7. 7-13 write the relevant code in the appropriate boxes. For example, if you are General, put

(A1) in the box against S.No. 9 Category.

14. If your name is RAJENDER KUMAR JUNEZA, then write as following in the boxes provided for.

15. Please write your Father’s/Husband’s/Mother’s name. If the name is MADHUBALA SEN,

then write it as follows:

16. For (a), write the relevant code in the box. If A1, then fill the column (b) also.

17. For Employment status write the relevant code in the box.

18. (a) Qualification codes are at Page No. _ in the Community College prospectus. Write the

relevant code for your eligible qualification.

(b) Write in the box main subjects taken for obtaining the eligible qualification.

A 1

2 5 0 6 1 9 8 3

R A J E N D E R K U M A R J U N E Z A

M A D H U B A L A S E N

Application Form

Please fill up the form and mail or submit in person the same along with copies of attested certificates to the Community College within the prescribed last date.

APPLICATION FORM: FOR FILLING ADMISSION INSTRUCTIONS

(c) Write the last 2 digits of the year of passing of the eligible qualification in the box.

(d) Write the division as 01, 02, 03 or 04 for the eligible qualification in the box.

(e) Write percentage of marks of the eligible qualification rounded off to nearest integer.

(f) For Board Code, refer to the Prospectus and fill the relevant code in the box.

19. For fee details, refer to the Prospectus and make a DD/Challan/Cheque in favour of your Community College, and fill

the relevant columns.

20. Fill the amount of DD/Challan/Cheque made in respect of Programme fee in the given box.

21. Write name of the bank in which you made a DD/Challan/Cheque.

22. Fill in your address for correspondences Do not give Post Box No. as address. Leave a box blank between each unit of

address like house No., street name, P.O. etc.

23. For 23-26, write down your landline Telephone Number, Fax Number, Mobile Number and e-mail address if any. Please

leave a box blank between STD code and Telephone/Fax Number.

CHECKLIST

Before sending the filled in form to concerned Community College, please check whether you have:

(a) Affixed your photograph.

(b) Enclosed the following attested certificates.

(i) Certificates in support of your educational qualification(s).

(ii) Category certificates for SC/ST/PH/OBC (non-creamy layer) Minority candidates.

(iii) Age certificate wherever required.

(iv) Student Card duly filled in along with photograph.

(c) Paid the fee following the prescribed procedure.

N.B: In case of Below Poverty Line students, documentary proof (photocopy of BPL ration card) is to be attached separately.