STUDENT COPY

NAVSAHYADRI COLLEGE OF EDUCATION,KHED,PUNE (62373)

Yashwantrao Chavan Maharashtra Open University Application No :

Dnyangangotri Near Gangapur Dam, Nashik, Pin Code-422222, Maharashtra(India)
Academic Year: 2023-2024
289101
Distance Education
YCMOU Study Center Submission Slip
ADMISSION FORM
Instruction:
Please submit copy of this submission slip with following list of document to Study Center for Recommendation of
Program for Admission and/or Recommendation of Scholarship.
Please note that application shall be considered for admission only after recommendation by study center
If recommendation by study center not completed before last date of admission your application will be automatically
cancelled. Please note that university will not refund the fees in case of rejection by study center for want of Eligibility.

Course Applied for : G01-B.A.(with Credits) - Distance Education - PRN:2022017001466986

2000 Pattern - S.Y.B.A. (G01)

Application Date : 30/07/2023 Payment Category : 8

Exam Center Name [Code] : - [-]
1.Personal Information
Candidate's Name(Regional) :
Candidate's Name as printed
SINGH ADITYA RAVIPRATAP
on School leaving/Passing
[*This name will appear on all University records/documents]
Certificate :
Mother's
Father's/Husband's Name : RAVIPRATAP SAROJ
Name :
Mother
Marital Status : UnMarried
Tongue :
Place Of Birth : Gorakhpur Gender : Male Date of Birth (DD/MM/YYYY) : 04/05/2003
Blood Group : Religion : Country of Citizenship : India
Weight : Not
Height : Not Available Hemoglobin : Not Available
Available
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :
Location Area : Not
State : Maharashtra District : Pune Tehsil : Khed City/Town/Village :
Available
Address (House
no,street/area/suburb Navsahyadri College Of Education Chakan Bhujbal Ali Pin Code : 410501
etc.) :
Contact details
Mobile
918888845441 Primary Email ID: adityams7172@gmail.com
Number
2.Legal Reservation Information
Category Type :
Category : GEN
Open
Is Guardian from EBC (Economic
Is Specially Abled? No
Backward Class)? No
3.Social Information(Additional Inforamtion)
Not Applicable
Paper Selected for:
S.Y.B.A.
ENG214 - How to Read a Short Story ENG215 - How to Read a Novel
HIS220 - Aadhunik Bharatcha Itihas HIS221 - Aadhunik Jagacha Itihas
POL224 - Bharatiya Rajkaranachi Prakriya POL225 - Aaple Hakka Aani Tyanchi Paripurti
EVS201 - Environment Studies
T.Y. B.A.

Medium of Instruction : Marathi

Admission Fee Payment
Fee Category : Regular Fees Over All Payment Status: : Paid
Details
Sports Fees(N) - 50 NSS Fees(N) - 10
Disaster Management Fees(N) - 10 Chancellor Office Events Fees(N) - 38
Registration Fee(N) - 200 Eligibility Fees(N) - 0
Identity Card Fees(N) - 0 E-Suvidha / E-Services Fees(N) - 60
Library Fee(N) - 10 DSW Fees(N) - 50
Alumni Fees(N) - 0 Sanvad Fees(N) - 10
Graduation/Convocation Fees(N) - 0 Student Insurance Fees(N) - 10
Tuition Fees(N) - 1600 Adm Examination Fees(N) - 910
Course Exemption Fees(N) - 0 Prospectus Fees(N) - 50
Tuition Fees(LSC - 2nd Year)(N) - 600 Total : 3608
Payment
Amount Transaction Date Transaction Number Transaction Type
Status
3608 Un-paid 30/07/2023 05:30:54 2195591690738254872 Online Payment
4.Guardian Information
Occupation of Guardian : Farmer Annual Income of Guardian : 100000
5.Educational Details
Month Exam
Name of Name of Board/University Name of Certificate Mark Out
and Year Seat CGPA %
Examination and State of University School/College No. Obtained Of
of Passing No.
MAHARASHTRA STATE
Std 12th 12Th BOARD OF SECONDARY March
-- -- 470.00 600.00 -- - -- 78.33
(Science) AND HIGHER SECONDARY 2021
EDUCATION,
Your Last Qualifying Exam:
7.Other Information
Would you like to apply for Hostel accommodation required NA
Required Documents and Certificates Section:
Statement of Marks of Qualifying Exam (पात्रता परीक्षेची गुण पत्रिका)

Passing Certificate of Std 10th.

Passing Certificate of Std 12th / Statement of Marks of Std 12th.

DECLARATION
I hereby declare that all the information furnished by me in this application form is true, complete and correct to the best of my
knowledge and belief. I do understand that I need to obtain and produce all the required documents. I admit to having
understood what constitutes ragging and sexual harassment. I have read the guidelines related to the same. I hereby affirm that if
found guilty of ragging or sexual harassment I am liable for punishment according to the university regulations.

Place : Date :
( Signature of the Candidate )
[STUDY CENTER COPY]

NAVSAHYADRI COLLEGE OF EDUCATION,KHED,PUNE (62373)

Yashwantrao Chavan Maharashtra Open University Application No :

Dnyangangotri Near Gangapur Dam, Nashik, Pin Code-422222, Maharashtra(India)
Academic Year: 2023-2024
289101
Distance Education
YCMOU Study Center Submission Slip
ADMISSION FORM
Instruction:
Please submit copy of this submission slip with following list of document to Study Center for Recommendation of
Program for Admission and/or Recommendation of Scholarship.
Please note that application shall be considered for admission only after recommendation by study center
If recommendation by study center not completed before last date of admission your application will be automatically
cancelled. Please note that university will not refund the fees in case of rejection by study center for want of Eligibility.

Course Applied for : G01-B.A.(with Credits) - Distance Education -

2000 Pattern - S.Y.B.A. (G01)
PRN:2022017001466986

Application Date : 30/07/2023 Payment Category : 8

Exam Center Name [Code] : - [-]
1.Personal Information
Candidate's Name(Regional) :
Candidate's Name as printed
SINGH ADITYA RAVIPRATAP
on School leaving/Passing
[*This name will appear on all University records/documents]
Certificate :
Mother's
Father's/Husband's Name : RAVIPRATAP SAROJ
Name :
Mother
Marital Status : UnMarried
Tongue :
Place Of Birth : Gorakhpur Gender : Male Date of Birth (DD/MM/YYYY) : 04/05/2003
Blood Group : Religion : Country of Citizenship : India
Weight : Not
Height : Not Available Hemoglobin : Not Available
Available
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :
Location Area : Not
State : Maharashtra District : Pune Tehsil : Khed City/Town/Village :
Available
Address (House
no,street/area/suburb Navsahyadri College Of Education Chakan Bhujbal Ali Pin Code : 410501
etc.) :
Contact details
Mobile
918888845441 Primary Email ID: adityams7172@gmail.com
Number
2.Legal Reservation Information
Category Type :
Category : GEN
Open
Is Guardian from EBC (Economic
Is Specially Abled? No
Backward Class)? No
3.Social Information(Additional Inforamtion)
Not Applicable
Paper Selected for:
S.Y.B.A.
ENG214 - How to Read a Short Story ENG215 - How to Read a Novel
HIS220 - Aadhunik Bharatcha Itihas HIS221 - Aadhunik Jagacha Itihas
POL224 - Bharatiya Rajkaranachi Prakriya POL225 - Aaple Hakka Aani Tyanchi Paripurti
EVS201 - Environment Studies
T.Y. B.A.

Medium of Instruction : Marathi

Admission Fee Payment
Fee Category : Regular Fees Over All Payment Status: : Paid
Details
Sports Fees(N) - 50 NSS Fees(N) - 10
Disaster Management Fees(N) - 10 Chancellor Office Events Fees(N) - 38
Registration Fee(N) - 200 Eligibility Fees(N) - 0
Identity Card Fees(N) - 0 E-Suvidha / E-Services Fees(N) - 60
Library Fee(N) - 10 DSW Fees(N) - 50
Alumni Fees(N) - 0 Sanvad Fees(N) - 10
Graduation/Convocation Fees(N) - 0 Student Insurance Fees(N) - 10
Tuition Fees(N) - 1600 Adm Examination Fees(N) - 910
Course Exemption Fees(N) - 0 Prospectus Fees(N) - 50
Tuition Fees(LSC - 2nd Year)(N) - 600 Total : 3608
Payment
Amount Transaction Date Transaction Number Transaction Type
Status
3608 Un-paid 30/07/2023 05:30:54 2195591690738254872 Online Payment
4.Guardian Information
Occupation of Guardian : Farmer Annual Income of Guardian : 100000
5.Educational Details
Month Exam
Name of Name of Board/University Name of Certificate Mark Out
and Year Seat CGPA %
Examination and State of University School/College No. Obtained Of
of Passing No.
MAHARASHTRA STATE
Std 12th 12Th BOARD OF SECONDARY March
-- -- 470.00 600.00 -- - -- 78.33
(Science) AND HIGHER SECONDARY 2021
EDUCATION,
Your Last Qualifying Exam:
7.Other Information
Would you like to apply for Hostel accommodation required NA
Required Documents and Certificates Section:
Statement of Marks of Qualifying Exam (पात्रता परीक्षेची गुण पत्रिका)

Passing Certificate of Std 10th.

Passing Certificate of Std 12th / Statement of Marks of Std 12th.

DECLARATION
I hereby declare that all the information furnished by me in this application form is true, complete and correct to the best of my
knowledge and belief. I do understand that I need to obtain and produce all the required documents. I admit to having
understood what constitutes ragging and sexual harassment. I have read the guidelines related to the same. I hereby affirm that if
found guilty of ragging or sexual harassment I am liable for punishment according to the university regulations.

Place : Date :
( Signature of the Candidate )
Document printed on Sun Jul 30 2023 17:34:18 GMT+0530 (India Standard Time)