8/26/2020

STUDENT COPY

N.D.M.V.P. SAMAJ`s COLLEGE OF EDUCATION (5401A)

Yashwantrao Chavan Maharashtra Open University

Application No :
Dnyangangotri Near Gangapur Dam, Nashik, Pin Code-422222, Maharashtra(India) 233611
Academic Year: 2020-2021
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 : M62 - M.A. in Education(with Credits) - Distance Education - 2016 CGPA - S.Y. M.A. in Education PRN:2018017002128577
Semester III (M62)

Application Date : 26/08/2020

Exam Center Name [Code] : - [-]
1.Personal Information
Candidate's Name(Regional) :
Candidate's Name as printed on School KUMAVAT MINAL RAJENDRA
leaving/Passing Certificate : [*This name will appear on all University records/documents]
Father's/Husband's Name : RAJENDRA KUMAVAT Mother's Name : PRATIBHA
Marital Status : Married Mother Tongue :
Place Of Birth : Pachora Gender : Female Date of Birth (DD/MM/YYYY) : 27/07/1995
Blood Group : Religion : Country of Citizenship : India
Height : Not Available Weight : Not Available Hemoglobin : Not Available
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :
Location Area : Not
State : Maharashtra District : Nashik Tehsil : Nashik City/Town/Village :
Available
Address (House
3 Pokar Peral,Pokar Colony Dindori Road, Nashik MERI Panchavti 422004 Pin Code : 422004
no,street/area/suburb etc.) :
Contact details
Mobile Number 917038607495 Primary Email ID: [email protected]
2.Legal Reservation Information
Category Type :
Category : NT-1 (NT-B)
Reserved
Is Specially Abled? No
3.Social Information(Additional Inforamtion)

Paper Selected for:

Semester III
EDU531 - Assessment in Education EDU532 - Evaluation in Education
EDU533 - Communication Modes in Education EDU534 - Communication Modes in Distance Education
Semester IV

PRI62 - Research Project And VIVA EDU535 - Educational Management

EDU536 - Educational Administration EDU537 - Educational Planning Part-I
EDU538 - Educational Planning Part-II GEN203 - Value Education

Medium of Instruction : Marathi

Admission Fee Payment Details Fee Category : Regular Fees Over All Payment Status: : Paid
Adm Exam Fee - 2200 Tution Fee - 2000
Registration Fee - 100 Development Fund Fee - 1050
Other Fee - 200 Total : 5550
Payment
Installment Amount Transaction Date Transaction Number Transaction Type
Status
1 5550 Paid 26/08/2020 11:20:41 1821481598484041518 Online Payment
4.Guardian Information
Occupation of Guardian : Farmer Annual Income of Guardian : 35000
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8/26/2020

5.Educational Details
Month
Exam
Name of Board/University and Name of and Year Certificate Mark
Name of Examination Seat Out Of CGPA %
State of University School/College of No. Obtained
No.
Passing
MAHARASHTRA STATE
BOARD OF SECONDARY AND March
Std 10th -- -- 462.00 550.00 -- - -- 84.00
HIGHER SECONDARY 2010
EDUCATION,
MAHARASHTRA STATE
BOARD OF SECONDARY AND February
Std 12th 12Th (Arts) -- -- 435.00 600.00 -- - -- 72.50
HIGHER SECONDARY 2012
EDUCATION,
Certificate : INTERMEDIATE
Directorate Of Art Maharashtra January
Drawing Grade Exam -- -- 150.00 234.00 -- - -- 64.10
State 2008
Certificate
Degree : B.A.(Bachelors)
May 2015 -- -- 720.00 1200.00 -- - -- 60.00
Degree
Diploma : DIPLOMA IN
Savitribai Phule Pune University June 2014 -- -- 1511.00 2000.00 -- - -- 75.55
EDUCATION Diploma
Degree : Diploma In School
Management(With Credits)- -- -
May 2019 -- -- 559.00 800.00 69.88
Distance Education-2016 First
Pattern
Your Last Qualifying Exam:
7.Other Information
Would you like to apply for Hostel accommodation required NA
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 )

2/4
8/26/2020
[STUDY CENTER COPY]

N.D.M.V.P. SAMAJ`s COLLEGE OF EDUCATION (5401A)

Yashwantrao Chavan Maharashtra Open University

Application No :
Dnyangangotri Near Gangapur Dam, Nashik, Pin Code-422222, Maharashtra(India) 233611
Academic Year: 2020-2021
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 : M62 - M.A. in Education(with Credits) - Distance Education - 2016 CGPA - S.Y. M.A. in Education
Semester III (M62)
PRN:2018017002128577

Application Date : 26/08/2020

Exam Center Name [Code] : - [-]
1.Personal Information
Candidate's Name(Regional) :
Candidate's Name as printed on School KUMAVAT MINAL RAJENDRA
leaving/Passing Certificate : [*This name will appear on all University records/documents]
Father's/Husband's Name : RAJENDRA KUMAVAT Mother's Name : PRATIBHA
Marital Status : Married Mother Tongue :
Place Of Birth : Pachora Gender : Female Date of Birth (DD/MM/YYYY) : 27/07/1995
Blood Group : Religion : Country of Citizenship : India
Height : Not Available Weight : Not Available Hemoglobin : Not Available
Is Student NRI/ Foreign National : No Domicile State: Maharashtra
Address For Correspondence :
Location Area : Not
State : Maharashtra District : Nashik Tehsil : Nashik City/Town/Village :
Available
Address (House
3 Pokar Peral,Pokar Colony Dindori Road, Nashik MERI Panchavti 422004 Pin Code : 422004
no,street/area/suburb etc.) :
Contact details
Mobile Number 917038607495 Primary Email ID: [email protected]
2.Legal Reservation Information
Category Type :
Category : NT-1 (NT-B)
Reserved
Is Specially Abled? No
3.Social Information(Additional Inforamtion)

Paper Selected for:

Semester III
EDU531 - Assessment in Education EDU532 - Evaluation in Education
EDU533 - Communication Modes in Education EDU534 - Communication Modes in Distance Education
Semester IV

PRI62 - Research Project And VIVA EDU535 - Educational Management

EDU536 - Educational Administration EDU537 - Educational Planning Part-I
EDU538 - Educational Planning Part-II GEN203 - Value Education

Medium of Instruction : Marathi

Admission Fee Payment Details Fee Category : Regular Fees Over All Payment Status: : Paid
Adm Exam Fee - 2200 Tution Fee - 2000
Registration Fee - 100 Development Fund Fee - 1050
Other Fee - 200 Total : 5550
Payment
Installment Amount Transaction Date Transaction Number Transaction Type
Status
1 5550 Paid 26/08/2020 11:20:41 1821481598484041518 Online Payment
4.Guardian Information
Occupation of Guardian : Farmer Annual Income of Guardian : 35000
5.Educational Details
3/4
8/26/2020

Month
Exam
Name of Board/University and Name of and Year Certificate Mark
Name of Examination Seat Out Of CGPA %
State of University School/College of No. Obtained
No.
Passing
MAHARASHTRA STATE
BOARD OF SECONDARY AND March
Std 10th -- -- 462.00 550.00 -- - -- 84.00
HIGHER SECONDARY 2010
EDUCATION,
MAHARASHTRA STATE
BOARD OF SECONDARY AND February
Std 12th 12Th (Arts) -- -- 435.00 600.00 -- - -- 72.50
HIGHER SECONDARY 2012
EDUCATION,
Certificate : INTERMEDIATE
Directorate Of Art Maharashtra January
Drawing Grade Exam -- -- 150.00 234.00 -- - -- 64.10
State 2008
Certificate
Degree : B.A.(Bachelors)
May 2015 -- -- 720.00 1200.00 -- - -- 60.00
Degree
Diploma : DIPLOMA IN
Savitribai Phule Pune University June 2014 -- -- 1511.00 2000.00 -- - -- 75.55
EDUCATION Diploma
Degree : Diploma In School
Management(With Credits)- -- -
May 2019 -- -- 559.00 800.00 69.88
Distance Education-2016 First
Pattern
Your Last Qualifying Exam:
7.Other Information
Would you like to apply for Hostel accommodation required NA
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 Wed Aug 26 2020 23:25:15 GMT+0530 (India Standard Time)

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