Blank

1. 2.

1. ProgrammeCode

8. Date of Birth

Date Month Year

9. Nationality A1 IndianB2 Others

3. RegionalCentre Code

11. Category(Write the relevantcode in the box)

17. Whether Kashmiri Migrant(Write the relevant code in the box)

12. Territory Code(Write the relevant code in the box)

A1 UrbanB2 RuralC3 Tribal

10. Sex(Write the relevant code in the box)

A1 MaleB2 Female

14. ReligionA1 Hindu D4 Sikh G5 ParsiB2 Muslim E5 Jain H8 JewsC3 Christian F6 Budhist I9 Others

13. Marital Status (Write the relevant code in the box)

A1 MarriedB2 Unmarried

18. Name of the Candidate (Leave one box empty between First Name, Middle Name and Surname)

19. Father's/Husband's Name/Mother's Name (Strick out whichever is not applicable)

20. Course Codes: M.Sc.(DFSM)/MTM/MLIS/MA (Edu)/MCA,BCA, BLIS/BA/B.Com/B.Sc./BSW/BTS/PGDDM/PGDMRR/CTE/PGDRD/CAFE/DCE & BPP (Students who are simultanously opting BPP along with DMT, DDT, DPVCPO and DPVAPFV)

(a) M.Sc. (DFSM)(Write the relevantcode in the box)

(c) MLIS (Optional Courses)

(d) BA/B.Sc./B.Com/BSW/BTS(Foundation Courses)

(e) BA/B.Sc./B.Com.(Elective Courses)

(g) CTE/DTS/PGDRD OptionalPGDDM/PGDMRR CoursesPGDBP/DPU etc.

(h) CAFE OptionalCourses

(i) DCE OptionalCourses

(j) BPP OptionalCourses

(k) MCA CS-60 A1

(l) BCA MTE-03 A1

(f) MA (Edu) Specialised Area A1 Higher Education A3 Educational Technology

A2 Distance Education A4 Educational Management

A1 CFNB2 CNCC

A1 Category 1B2 Category 2

(b) MTM(Write the relevantcode in the box)

15. Whether Minority(Write the relevant A1 Yescode in the box) B2 No

16. Social Status(Write the relevantcode in the box)

A1 Ex-servicemanB2 War widowC3 Not applicable

A1 YesB2 No

6. Medium Code(Write their level code in the box)A1 EnglishB2 HindiC3 Others

If other please specify

7a. Are you already registered with IGNOU A1 Yes(Write the relevant code in the box) B2 No

7b. If yes write the Enrol. No. & Program Code in the boxes below:Enrolment No. Programme Code

4. StudyCentre Code

5. StateCode

2. Enrolment No.(For office use only)

INDIRA GANDHI NATIONAL OPEN UNIVERSITYAPPLICATION FORM FOR WALK-IN-ADMISSIONS

Application Number

Control Number

(JANUARY / JULY SESSION)[Strike out the Session whichever is not applicable]

PHOTOGRAPH

Affixyour latest

passport sizephotograph

(4 cm x 5 cm)duly attested

A1 - GEN C3 - STB2 - SC D4 - OBC

D4 - A or D4 - B

(In case of OBC student, Pleasealso indicate code either)

(i) Creamy Layer - D4-A(ii) Non-Creamy Layer D4-B

To be Submitted at the Concerned Regional Centre only

Signature of Candidate

21(a) Whether a person with disability(Write the relevant code in the box)

A1 YesB2 No

23. Details of Scholarship being received if any:

(a) Annual ScholarshipAmount

24. Relevant Qualifications: (Which makes you eligible for the programme)

25. Details of Fees(Write the relevant code in box)B2 Cash Challan of BankB3 Bank Draft

27. Address for Correspondence (Do not give Post Box No. Leave a blank between each unit of address like House No., Street Name, P.O., etc. do not repeat Student Name/Father Name)

28.Landline Telephone Number (if any) with STD CodeSTD Code

29.Mobile Number (if any)

30.E-mail address/ID (if any)

DECLARATION BY APPLICANTI hereby declare that I have read and understood the conditions of eligibility for the programme for which I seek admission. I fulfil 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 University at any time and I shall not be entitled to refund of any fee paid by me to the University. Further, I have carefully studied the rules of the University as printed in the Prospectus and I accept them and shall not raise any dispute in future over the same rules.

Date

City

State Pin Code

District

Bank Name :

26. Amount(Add Rs. 200/- in case of Late fee

DD/Challan No.

DD/Challan Date

(a) Qualification (b) Main Subjects (c) Year of passing

(01, 02, 03 or04) for pass

(Do not useDecimals)

(Whereverrequired)

(d) Division (e) % of marks (f) Board Code

(Last 2Digits only)

Code

(b) Deptt. Offering (Write the relevant code in the box)

A1 Govt. Deptt. B2 Other

Scholarship (c)Family Income (yearly) (d) Below Poverty Line (e) In case of Jail in mates

21(b) If a person with disability (nature of disability)(Write the relevant code in the box)A1 Speech and Hearing ImpairmentB2 Locomotor ImpairmentC3 Visual impairmentD4 Low VisionE5 Any other, Please specify

22. Employment Status(Write the relevant code in the box)

A1 Unemployed C3 EmployedB2 IGNOU Employee D4 KVS Employee

Signature of CandidateCHECKLIST

A1 YesB2 No

A1 YesB2 No

Telephone No.

Guidance from the programme coordinator and teachers from the school