D. Y.

PATIL EDUCATION SOCIETY, KOLHAPUR

(Deemed to be University)
(Declared u/s 3 of the UGC Act 1956 vide Notification No. F.9-26/2004-U.3 dt. 01-09-2005 of the GOI)
NAAC ‘A+’ Grade in 3rd Cycle
869, ‘E’, D. Y. Patil Vidyanagar, Kasaba Bawada, Kolhapur-416 006
Phone No. : (0231) 2991436, (0231) 2601595
Web: www.dypatilunikop.org, E-mail: info@dypatilkolhapur.org

Application form for “Best Outgoing Student” Award

1. A student who has passed the UG final year examination of the programme is eligible to apply the
award.
2. Fill in, this application form completely and send a soft copy to bestoutgoings@gmail.com on
before January 30th, 2024 upto 5.00pm. If the application is received late, it will not be
considered.
3. Provide point-by-point brief summaries in accordance with the criterion title listed below, and
attach appropriate certificate(s) or other document(s), to support your claim.

Name of the Student:

(exactly as per last year Marksheet)

Admitted Programme:
Final year seat No.:
Permanent Registration number:
Address for communication:

Email:
Mobile Number:
Alternate Mobile Number:

Criterion-1: Academic achievements during the program of study.

Description:
Annexure-1:
Criterion-2: Participation in Social, Extracurricular and Co-curricular activities during the program of study.
Description:
Annexure-2:
Criterion-3: Participation in sports activities during the program.
Description:
Annexure-3:
Criterion-4: Punctuality and conduct during the program tenure.
Description:
Annexure-4:
Criterion-5: Laurels brought to the department/Institution.
Description:
Annexure-5:
Criterion-6: Projects completed, publications done, presentations done if any in academic events.
Description:
Annexure-6:
Criterion-7: Any other suitable criteria.
Description:
Annexure-7:

I confirm that, I have passed student of the D. Y. Patil Education Society (Deemed to be University),
Kolhapur. I agree to abide by the terms & conditions of the “Best Outgoing Student” Award. I confirm that all
information in this application and accompanying documents are correct to the best of my knowledge and
belief.

Date: Name & Signature of the Student

Note:
1. The award selection will be judged by a committee constituted by the Hon’ble Vice-Chancellor.
2. The decision of the committee will be final.