KTUJM

Kushabhau Thakre Patrakarita Avam Jansanchar Vishwavidyalaya,Raipur

Mail us : [email protected] (For Technical Help) Help Line No : 9406144818 (Any Other then Technical Help) (Time: 10.30 AM to 6.30 PM)

ACADEMIC SESSION-2019-20

Application Form for Admission to Various Courses in the University Campus

A COPY OF THIS FORM ALONG WITH THE COUNSELING/ ENTRANCE TEST Rs. 300/- (Rs. 150/- for SC/ST) IN DD, PHOTOSTAT/ SCANNED COPIES OF SCHOOL / DEGREE CERTIFICATES, AND CERTIFICATE INDICATING DATE OF BIRTH, BE SUBMITTED AT THE TIME OF COUNSELING/ ENTRANCE TEST.

Course Applied For :
01. Course
02. Department :
02. Details of Application Fees :
Mode of Payment
Amount :
Date of Payment/ DD Date (DD-MM-YYYY):
Deposit Journal No/ DD No. :
Bank Name :
Bank/Branch code :
Branch Name/City Name :
Personal Details :
03. Name in Full (As per 10th Marksheet):
04. Sex:
05. Category:
06. Date of Birth (DD-MM-YYYY):
Place of Birth:
07. Nationality :
Contact Details :
08. Address For Correspondence :
09. Email ID 10. Contact No. :
Parent Details :
11. Mother's Name
12. Father's Name/ Husband's Name
Photo & Sign :
Photo (JPEG/JPG Only, Not More Than 60kb): Sign (JPEG/JPG Only, Not More Than 60kb):
13. Education Qualifications:
Edu.Qualification
Board/Univercity
Year
Marks
 /
Out of
%Marks
Result
Subjects Studied
/
/
/
/
/
/
+