Application Form of Distance Education : JUL-2022

Marked with*fields are mandatory
Department and Course Details
Department Name Centre For Distance Learning & Continuing Education (ODL)
Select Course Type*
Select Course*
Applicant's Details
Applicant Name *


Father's/Husband Name *       
Mother's Name*    
Date of Birth*
Gender*
Medium*
Nationality*
Whether domicile of Madhya Pradesh* Category*
Blood Group* E-mail ID
Mobile*
(Is your mobile number same as whatsApp No.)
*Please enter active Mobile Number and E-Mail Id for further communication.
Correspondence Address
Address Line 1*
Correspondence Address Line 1 Max. 100 character.
Address Line 2 *
Correspondence Address Line 2 Max. 100 character.
State*
District*

City*
Pin Code*
Particulars of the Last qualifying examination
Exam Passed* University/Board*
Passing Year*  Enroll No. *  
Obtain Marks*   Total Marks *  
Old (ODL) Student *  
Document Forwarding Center Details 
Coordinator Name*    
Coordinator Name Mobile No.
Address
Academic qualification
Class Course Roll No Passing Year Obtain Marks Total Marks Percentage Board/ University
10+2/
Polytechnic Diploma*








Attachments
10th Marksheet scan copy: *
(Scan copy in .pdf/.JPG format and size between 100 KB to 300KB)
12th Marksheet scan copy*
(Scan copy in .pdf/.JPG format and size between 100 KB to 300KB)
Upload Photo with Signature
Upload Photo with Signature*
Declaration
सूचना: ऑनलाइन फॉर्म भरने एवं शुल्क भुगतान करने की सुविधा सीधे छात्रों को उपलब्ध कराई गई है। अतः आवेदक स्वयं फॉर्म भरें एवं शुल्क का भुगतान करें। किसी अन्य व्यक्ति या इंटरनेट कैफे से किये गए भुगतान हेतु आवेदक स्वयं जिम्मेदार होंगे।
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