Bal Gangha Dhaar Tilka

Pages: 5 (693 words) Published: June 20, 2013
Print

Form No- OL13-1020-006640

POST-GRADUATE TEACHING DEPARTMENTS VANI VIHAR, BHUBANESWAR-751004 ONLINE APPLICATION FORM FOR ADMISSION FOR MASTERS PROGRAMS

Utkal University

Close

Name of the Course: Physics
For office use only

Index No: Career Mark: Entrance Test Marks: Total marks : Head of Department:

Date of Admission: Verifying Officer: Roll No: Position in the list: Admission in Charge: Applicant details :

Applicant's Name : Father's/Guardian Name: Nationality : Mother Tongue : Email :

PREETI POONAM BEBARTA KRUSHNA CHANDRA BEBARTA Indian Odia poonambebarta@gmail.com

Gender : Date Of Birth : Religion : Martial status :

FEMALE 27-04-1993 HINDU NO

Present Address :

C/o : Addr Line 1 : Addr Line 2 : PIN :

KRUSHNA CHANDRA BEBARTA AT-119 COLONY PO/DISTMALKANGIRI 764048 Contact No : 9439272708 Permanent Address :

C/o : Addr Line 1 : Addr Line 2 : PIN :

KRUSHNA CHANDRA BEBARTA AT-119 COLONY PO/DISTMALKANGIRI 764048 Contact No : 9439272708 Payment :

SL.No Amount 1. 2. 150 350

Demand Draft 493209 493208

DATE 19-06-2013 19-06-2013

BANK STATE BANK OF INDIA STATE BANK OF INDIA
Reservation Details :

eadmission.utkaluniversity.ac.in/modules/form/print.php

1/3

Caste: Physically handicapped: Children Of Ex-Serviceman: Represent country in international sports: Representing State at National Level Sports during last 3 years:

General Category Candidate NO NO NO NO

Serving Defence Personal: Children of Martyrs: Domicile of odisha living in outside state: Odia living in neighbouring state: Representing University at Inter-University sports during last 3 years:

NO NO NO NO NO

Other University details :

Hostel Accommodation: Whether Admitted/Passed/Completed any other PG Courses: Whether admitted to any other course : University : College :

YES NO

Utkal University Registration No:

NO Course :

Criminal antecedents/Criminal Cases : Whether Employed : Name of the organisation Designation and nature of Date of joining the service

NO NO Date of Relieve (if any)

Academic Career details

Exam Passed 10th or equivalent +2 Science

Year 2008 2010

Board/University CBSE CHSE

Division/ Subject Offered Grade 1ST 1ST ALL SUBJECT

Mark Full Secured Mark 346 500

Mark Percentage 69.20 70.00

PHYSICS,CHEMESTRY,BIOLOGY 600 420

Exam Passed

Year

Board/University

Division/ Grade 1ST

Hons Subject

(Mark Total Secured Full Mark Only Mark Secured Hons) 1369
Grad Percentage:

B.Sc

2013

BERHAMPUR UNIVERSITY

PHYSICS

639 76.05

1800

If you have not taken any Honours subject leave the Space for Hons. Subject BLANK N.B:Use space between words in the field provided for Subject e.g., ENG, FLO, TLS etc.

Distinction YES : Full Marks In Hons : 800

Essential Enclosures & Declaration

List of Enclosures( attested certificates/documents) to be send to respective HOD/Coordinator : 1. Self-Certified copies of the following as required : 2. Mark sheets and Certificates of all examinations. eadmission.utkaluniversity.ac.in/modules/form/print.php 2/3

3. SC/ST Certificate from the competent authority (MP/MLA/Collector/ADM/SDO/Local Gazetted Revenue officer not below the rank of Deputy Collector or tahasildar.) 4. Self attested passport size photograph of applicant to be pasted on the first page of the application form. Attach two more copies with the form. 5. Physically handicapped certificate and ID card issued by District Welfare officer/ Community Development Officer/Social welfare Department of State Government. 6. Sports and Game Certificate of participation are required for special weightage consideration, from the competent Authority-Director of Sports/ Sports Council of the University countersigned by the Principal/HOD of the College/Department. 7. Two Demand Drafts/BC (Write your name, application number and course applied for on the back side of the bank draft/ back side of the Photocopy of the receipt of...
Continue Reading

Please join StudyMode to read the full document

You May Also Find These Documents Helpful

  • BAL Essay
  • Essay about Bal Gangadhar Tilak
  • lol my bals Essay
  • Hr Policies of Ibm by Bal Research Paper
  • Essay on Bal Case Study
  • Essay about BAL case study
  • Operational Strategy of Bal and Hmc Essay
  • Scoliosis Presentation by Shan BAL Essay

Become a StudyMode Member

Sign Up - It's Free