APPLICATION FOR ADMISSION TO PGDTDM4 BATCH(2015)

NATIONAL INSTITUTE OF RURAL DEVELOPMENT &
PANCHAYATI RAJ
(Ministry of Rural Development, Government of India)
APPLICATION FOR ADMISSION TO PGDTDM4thBATCH(2015)
(Recognised by University Grants Commission, New Delhi)
Last date forreceivingfilled in ApplicationForm:28-11-2014
Application-cum-RegistrationForm
ReadtheProspectus and Instructionscarefullybeforefilling up theapplicationform
available in NIRD Website (www.nird.org.in/Distance EducationCell/PGDTDM/News &Events )
COURSE APPLIED FOR PGD-TDM
Application No:
CATEGORY: GEN/OBC/SC/ST/ PH
D.D. No:
To be filledby office
1. Name of theStudent (Same as in SSC/Matriculation Certifícate) in Capital Letters
Paste here a recent
Passport
size
Photograph
duly
attested by the
Head
of
the
Institute / College
last attended or by
a GazettedOfficer
Mr./Ms./Mrs……………………………………………………………………………………….
(a) Father’sName……………………………………………………………………………
(b)Mother’sName……………………………………………………………………………
2. (a) PermanentAddress:
2. (b) AddressforCorrespondence
………………………………………………………………………….
…………………………………………………………………………………
………………………………………………...........................
………………………………………………………………………………...
PIN……………….Phone/Mobile No……………….
PIN……………… Phone/Mobile No…………………………….
Email:……………………………………………………………………….
3. a) Date of Birth …………………………………………………………………………………………………………..
Date
MonthYear
b) Identification Marks 1)………………………………………….
2)……………………………………………..
c) Nationality :Indian / Foreign………………
IfIndian, State of Domicile : ……………………………………………………………
IfForeignNational, name of Country………………………………………………………
d) Gender:Male / Female
Pin Stamp
Size
Photograph
for ID Card
Purpose
4. SpecimenSignature of theStudent (Signwithinthe box)
5.Particulars of academic record - pleaseattachattested copies of testimonials.
Examination
Board /
College/
University
Month&
Year of
Passing
Subjects
Studied
and
Passed
Maximum
Marks
Marks
Obtained
Percentage
Division
10th Class/ High
School
Degree
(B.A./B.Sc./B.Com./
LLB.,/B.E./B.Tech./
B. Lib.)
DECLARATION BY THE APPLICANT
I, S/D of Sh……………………………….……………….. hereby declare thatalltheinformationfurnishedby me in
thisapplication and in thedocuments I havesubmitted in support of myapplication are true, complete and
correct to thebest of myknowledge and belief.
Place:
Signature of theCandidate
Date:
FOR SPONSORED CANDIDATES
Application of Sh/Ms------------------------------- isforwardedforconsideration. Onhis/heradmission, full
Programme Feewill be deposited.
AuthorisedSignatory of SponsoringOrganisation
Seal
Note:
Filled in applicationformalongwithDemandDraft (Rs. 500/-for Gen/OBC category -Rs 300/- forSC /ST/PHcategory) drawnin
favour of
NIRD-DEC-PGD-SRD, payable at Hyderabadand supported Xerox copies of theCertificates as
detailedbelowmayplease be sent to Project Director, DEC, NationalInstitute Of Rural Development&PanchayatiRaj,
Rajendranagar, Hyderabad 500 030 (Telangana) to reachonorbeforethedue date as mentionedabove.
Attachonlyattested copies of thecertificates. Tickmarkthe boxes
certificatesshould be presentedforverifi cation at the time of admission.
againstthedocumentsattached. The original
Secondary School Certificate (SSC) or High School Certificate (date of birth proof)
Final Degree Certificate/Provisional Certificate
SC/ST/ PH Certificate from competent authority
Programme Fee Particulars :
1. General/OBC
2. SC, ST & PH
-
Rs. 10,000/- (to be paid in two equal installments)
Rs. 9,000/- (to be paid in two equal installments)