APPLICATION FORM

Bachelor of Liberal Studies

A D M I S S I O N 2 0 11

Pandit Deendayal Petroleum University

Raisan, Gandhinagar - 382 007. Gujarat, India. Ph.: +91-79-23275210/11/12 Fax: +91-79-23275030 Email: slsadmission@pdpu.ac.in | Web site: www.pdpu.ac.in

*: PDPU has proposed to UGC to approve nomenclature of the new degree in Liberal Studies as BLS (Bachelor of Liberal Studies), failing which
the university will award a B.A. Honours or B.B.A Honours (based on the selection of Major) and a Diploma of Liberal Studies.

Liberal Studies Admission Form_2011

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PERSONAL INFORMATION
For Office Use Only

Application No. 1. Name of the Candidate (in Capital Letters) First name Last name 2. Gender: Male Female 3. Blood Group:

Middle name

4. Date of Birth: 5. Nationality: 6. Category: 7. Mother Tongue: 8. Languages Known: Day Month Indian NRI General SC Year POI ST Physically Challenged

(Caste certificate should be produced as authorized translation in English, Hindi or Gujarati)

CONTACT INFORMATION
CORRESPONDENCE ADDRESS City/Town Country
Country Code Area Code

State Pin code

Phone No.

Land line No. : Mobile: PERMANENT ADDRESS City/Town Country

Country Code Area Code

State Pin code

Phone No.

Landline No. : Mobile: Primary E-mail: Parents E-mail : Liberal Studies Admission Form_2011 Page 2

9. Mothers Maiden Name: 10. Parents/Guardians Name: 11. Relationship with guardian: 12. Parents/Guardians Occupation: Father
Agriculture

Mother
Law Medical

Other (specify):________________________
Private Service

Teaching/Research Public/Govt. Service

Business
Defense

Engineering

Other (Specify): _______________________ Between 1-2 lakh Between 7-10 lakh Between 2-4 lakh Above 10 lakh

13. Parents/ Guardians Income (Rs. per annum) :

Below 1 lakh Between 4-7 lakh

ACADEMICS
Examination University/Board Principal Subjects Yr. of Passing Percentage/CGPA SSC HSC Any Other Medium of Study

HOBBIES

EXTRA CURRICULAR ACTIVITIES

Sr. No. Year/Duration Activity Role Played Award/Recognition National/State/Local

WHY I WANT TO JOIN SLS (Max.100 Words)

Liberal Studies Admission Form_2011

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APPLICATION FEE (A NON-REFUNDABLE FEE OF RS.1,200/- )

(i) (ii) Demand Draft in favour of Pandit Deendayal Petroleum University payable at Ahmedabad Mention Candidates Name, Contact Number & Address at the back of the DD.
Demand Draft No. Date Amount

Issuing Bank

Branch & City

DECLARATION

I hereby declare that the entries made in this application form are correct to the best of my knowledge and belief. I note that the decision of the University is final with regard to admission and assignment to a particular department and field of study. In case of any information furnished by me is found to be incorrect, the University has the right to take any action it deems fit, including expulsion at any time after admission. If admitted, I promise to abide by the rules and regulations of the PDPU. I also understand that after getting confirmed admission, if I wish to cancel the same, `.72,000/- (after deducting the Processing Fees of `.1000/-) will be refunded by the University, in case I inform the University about my withdrawal of admission in writing, on or before 23-6-2011. If I withdraw the admission after 23-6-2011 only the Caution Money Deposit of `.10,000/- and Library Deposit of `.3000/- (i.e. total `.13000/-) will be refunded in case the seat remains vacant.

Place : ____________________

_____________________________ Signature of the Candidate ___________________________________ Signature by Parent/ Guardian

_____________________________ Name of Parent/Guardian

Important Instructions: (i) Please send the completed application form along with the DD to School of Liberal Studies, PDPU, by 6th June, 2011 (ii) The University has tied-up with DTDC courier to deliver daily mail. Therefore, we recommend you to send your application form through DTDC courier. You can also send us the application form through registered post. (iii) Your envelope must be super-scribed School of Liberal Studies - Admission 2011

Liberal Studies Admission Form_2011

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To be filled by the candidate along with Application form

SCHOOL OF LIBERAL STUDIES PANDIT DEENDAYAL PETROLEUM UNIVERSITY ADMISSION 2011-15 ADMIT CARD A For Office Use

Candidates Name: Parents /Guardians Name: Address:

Signature of the Invigilator

For Office use only. (To be signed by Invigilator present at Test Centre after due identity verification.)

Signature of the Candidate

( To be signed by the applicant in presence of the Invigilator at the time of appearing for the test.)

Signature of the Candidate

Attestation by Gazzeted Officer

To be retained by the candidate and to be carried to the test centre

SCHOOL OF LIBERAL STUDIES PANDIT DEENDAYAL PETROLEUM UNIVERSITY ADMISSION 2011-15 ADMIT CARD B Candidates Name : Parents /Guardians Name: Address :

Examination Centre: Date: 12th June, 2011

PDPU, Raisan, Gandhinagar.

Signature of the Candidate

Important Instructions: 1. Candidate shall be admitted to the examination hall on production of this Admit Card. The Admit Card should be presented to the invigilators for verification. 2. Candidate is required to report at the test centre venue at least 45 minutes before the scheduled time of the commencement of the test. 3. No candidate shall be admitted 15 minutes after the commencement of the test.

Also no extra time will be granted for completing the Attestation by test. Gazzeted Officer 4. Candidates are expected to retain a copy of their filled application form. 5. Please carry ball point pen, HB pencil, eraser and sharpener to the test center along with this admit card. Signature of the Invigilator 6. Candidate is not permitted to carry books, (To be signed by Invigilator present at Test Centre calculators, mobile phones or any other such after due identity verification.) instruments.

Liberal Studies Admission Form_2011

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