Application Number: Centre For Distance Education

CENTRE FOR DISTANCE EDUCATION
ACHARYA NAGARJUNA UNIVERSITY :: NAGARJUNA NAGAR - 522 510, AP.

ICR APPLICATION FORM for U.G./P.G./Diploma/Certificate Courses
For Office Use Only
6. Name of the Candidate and Father's Name (CAPITAL LETTERS ONLY) as per SSC or its equivalent examination / Notary
7. Sex
M = Male
F = Female
9. Date of Birth
As per SSC Notary
10. Reservation
Category
Code
8. Marital Status
M = Married
U = Un-Married
NOTE : Please fill this ICR Sheet only in ENGLISH with CAPITAL letters. Read the Instructions overleaf & Prospectus carefully before filling this form
Name of
the
Candidate
1 9
11. Religion
12. Nationality
5. Fee Particulars
14. Address for Communication
Phone No.
Phone
(if any) STD Code
Mobile No.
(If any)
Paste Recent
Passport size
Photograph ONLY
within this box.
Do not staple / pin &
Do not sign on
the Photograph
Signature of the Candidate
(inside the box above)
Y=YES
N= NO
Father's
Name
Name of the
Issuing Bank
Day Month Year
2 0
2. Choice of Study Centre Code (See prospectus for codes)
I Priority II Priority III Priority
1. Code No. of the Course Applied
(See Prospectus for codes)
3. Medium of Instruction
E=English T=Telugu
4. Second Language
S=Sanskrit T=Telugu H=Hindi
Amount
DD No./J.No.
(In case of UG Courses)
(See Prospectus for availability)
13. Details of Qualifying Examination Passed :
Fold along the doted
line
PIN Code
C/o
Door No. /
House No.
Street / Village
Mandal/Town
District
If Yes, Course
15. Are you studying any other Course offered by CDE, ANU at present.
(Candidate should not join in more than one course at a time)
E-mailID:_______________________________
YEAR
Batch
AY CY 2 0
Cost of Application Rs.15 + Registration and Processing Fee Rs.95 = Total Rs.110/-
Application Number
Enrollment Number Registration Number
Name of the Board /
University
Qualifying Exam
Passed
GROUP
SUBJECTS
Regd. No. of
Qualifying Exam
Year of Passing
1.
2.
3.
Total Marks
(Except IHC, Sci. & Civi., Env. Sci.)
Marks Secured
Aggregate Marks (%)
(Except IHC, Sci. & Civi., Env. Sci.) .
Day Month Year
YEAR
Batch
AY CY
2 0
DOB, PC, Marks
Certificate Verified by Name
Admission given by Name Signature
Signature
CENTRE FOR DISTANCE EDUCATION
ACHARYA NAGARJUNA UNIVERSITY :: NAGARJUNA NAGAR - 522 510, AP.
ADMISSION APPLICATION FORM for U.G./P.G./Diploma/Certificate Courses
For Office Use Only
6. Name of the Candidate and Father's Name (CAPITAL LETTERS ONLY) as per SSC or its equivalent examination / Notary
7. Sex
M = Male
F = Female
9. Date of Birth
As per SSC Notary
10. Reservation
Category
Code
8. Marital Status
M = Married
U = Un-Married
NOTE : Please fill this ApplicationForm only in ENGLISH with CAPITAL letters. Read the Instructions overleaf & Prospectus carefully before filling this form
Name of
the
Candidate
1 9
11. Religion
12. Nationality
5. Fee Particulars
14. Address for Communication
Phone No.
Phone
(if any) STD Code
Mobile No.
(If any)
Paste Recent
Passport size
Photograph ONLY
within this box.
Do not staple / pin &
Do not sign on
the Photograph
(inside the box above)
Y=YES
N= NO
Father's
Name
Name of the
Issuing Bank
Day Month Year
2 0
2. Choice of Study Centre Code (See prospectus for codes)
I Priority II Priority III Priority
(See Prospectus for codes)
E=English T=Telugu
4. Second Language
S=Sanskrit T=Telugu H=Hindi
Amount
DD No./J.No.
(In case of UG Courses)
(See Prospectus for availability)
13. Details of Qualifying Examination Passed :
Fold along the doted
line
PIN Code
C/o
Door No. /
House No.
Street / Village
Mandal/Town
District
If Yes, Course
15. Are you studying any other Course offered by CDE, ANU at present.
(Candidate should not join in more than one course at a time)
E-mailID:_______________________________
YEAR
Batch
AY CY 2 0
Cost of Application Rs.15 + Registration and Processing Fee Rs.95 = Total Rs.110/-
Application Number
Enrollment Number Registration Number
Name of the Board /
University
Qualifying Exam
Passed
GROUP
SUBJECTS
Regd. No. of
Qualifying Exam
Year of Passing
1.
2.
3.
Total Marks
Marks Secured
Aggregate Marks (%)
(Except IHC, Sci. & Civi., Env. Sci.) .
Day Month Year
YEAR
Batch
AY CY
2 0
DOB, PC, Marks
Certificate Verified by Name
Admission given by Name Signature
Signature
INSTRUCTIONS AND EXAMPLES TO FILL IN THE ICR SHEET
1. This ICR Sheet is designed for computerization purpose and it should be handled carefully. It should not be mutilated or folded.
Mutilated or folded forms will not be accepted.
2. ICR Sheet should be filled properly within the box and legibly by the candidate in his/her own handwriting with ball pen Blue or Black
in CAPITAL LETTERS only.
3. Please do not overwrite on the ICR sheet.
4. Only good quality recent passport size photograph should be pasted on the ICR sheet. Please do not staple or pin the photograph.
Please do not sign on the photograph pasted. Attestation should not be done on the photograph.
For example M.Sc. Mathematics
Refer the Prospectus for Course Code
2. Choice of Study Centre Code
For example :
Mahatma Gandhi College, GUNTUR
Refer Annexure - I in the Prospectus for Study Centre Code
0 2
7. Sex
M = Male
F = Female
For Example,
if Male
Leave one blank space after each initial or word in the name.
For example : For DHANEKULA KRISHNA RAO
01=SC
6. Name of the Candidate should be in 'CAPITAL LETTERS' only.
M
M = Married
U = Un-Married
For Example,
if Un-Married U
SIMILAR PROCESS FOR ITEM NO 14
10. Reservation Category Code
(Enclose Xerox Copy)
05=ST
06=BC-A
07=BC-B
08=BC-C
09=BC-D
10=PH-VH (Visually Handicapped)
11=PH-HI (Hearing Impaired)
12=PH-OH (Orthopaedically Handicapped)
0 6
11. Religion
01. Hindu 02. Muslim 03. Christian 04. Others
0 1
For Example,
if Hindu
UNDERTAKING
I...................................................... S/o / D/o ............................................................................ hereby undertake to abide by the rules,
regulations and stipulations of CDE, ANU and I am aware that the legal jurisdiction in respect of all legal matters arising out of my
Admission for any course, examinations or any other issues, is restricted to the University head quarter, Guntur only. I further agree
that the courts/consumer forum outside the Guntur will have no jurisdiction.
I further state that, I shall abide by the regulations of the Centre / University incorporated in the Prospectus and also those issued
from time to time during the course of my study. I also declare and state that all the particulars furnished in the Admission Form are
true and correct to the best of my knowledge and if any information is found to be contrary to the rules, my admission shall stand
cancelled and I am liable for penal action as the CDE, ANU deems fit. As such I will not any claims for refund of fees.
1. The Application must be accompanied by a DD for the Prescribed amount drawn in favour of "The Director, Centre for Distance
Education, Acharya Nagarjuna University", payable at SBI or Andhra Bank, Nagarjuna Nagar - 522 510.
2. The candidates who passed the qualifying examination from Universities other than Acharya Nagarjuna University and seeking admission
into PG courses are required to pay Rs. 100/-, in addition to the fee, towards Recognition Fee.
3. Candidates must produce their original certificates for verification, within two months from the date of Provisional admission given on the
basis of Xerox copies of certificates enclosed with the application.
Station :
Date :
0 1
For Example, if SC
12. Nationality
01. Indian 02. Others
For Example,
if Indian
0 1
E=English T=Telugu
For example English
E
4. Second Language
S = Sanskrit T=Telugu H=Hindi
For example Sanskrit
S
(Refer the Prospectus for medium available)
(For UG Courses only)
13. Qualifying Examination Passsed
M A T H E M A T I C S
P H Y S I C S
C H E M I S T R Y
Group Subjects
For Example,
if Inter (MPC)
I N T E R
1.
2.
3.
B O T A N Y
Group Subjects
For Example,
if B.Sc.
(B.Z.C)
B S C
1.
2.
3.
Z O O L O G Y
C H E M I S T R Y
9. Date of Birth as per
for example if date of
birth is SSC 13-04-1975
Day Month Year
1 3 0 4 1 9 7 5
13=OC
Name
of the
Candidate
Father's
Name
SSC Notary
8. Marital Status
Note : Arrange enclosures in the following order :
1. Identity Card 2. Demand Draft / Online Payment receipt with J No. 3. ICR Application Form 4. Application Form 5. Xerox copy of date of Birth
(SSC or equivalent or Notary)
6. Xerox copies of Provisional Certificate and Marks Statements of Qualifying Examination passed.
7. Attested Xerox copy of Lower Original Degree (Concerned Bachelors Degree)
8. Candidates belonging to reserved categories must produce Xerox Copy of Caste Certificate/PH/NCC/Sports.
CDE will send important messages through SMS, if Mobile Number is given.
D H A N E K U L A
K R I S H N A
P A D D A I A H
R A O

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CENTRE FOR DISTANCE EDUCATION

ACHARYA NAGARJUNA UNIVERSITY :: NAGARJUNA NAGAR - 522 510, AP.

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