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Online Form PDF

This document is an admission form for continuing education courses offered online by the Department of Life Long Learning and Extension at a Mumbai university. It requests information such as name, date of birth, gender, category, educational qualifications, address, payment details, and a signature agreeing to the instructions and regulations. The instructions specify that the course is only available online, a login will be provided, exams can be taken within 6 months, 100% attendance is required to receive a certificate, and only demand drafts are accepted for payment.

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Fast Nirmal
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47 views2 pages

Online Form PDF

This document is an admission form for continuing education courses offered online by the Department of Life Long Learning and Extension at a Mumbai university. It requests information such as name, date of birth, gender, category, educational qualifications, address, payment details, and a signature agreeing to the instructions and regulations. The instructions specify that the course is only available online, a login will be provided, exams can be taken within 6 months, 100% attendance is required to receive a certificate, and only demand drafts are accepted for payment.

Uploaded by

Fast Nirmal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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DEPARTMENT OF LIFE LONG LEARNING AND EXTENSION

Vidyapeeth Vidyarthi Bhavan, Second Floor, 'B' Road, Churchgate, Mumbai- 400020.
Contact Tel.No 022-65201654, Telefax 022 22813020
Website: http://www.mudlle.ac.in E-Learning Portal: http://www.lms.mudlle.ac.in Email: [email protected]

ADMISSION FORM FOR CONTINUING EDUCATION COURSE(ONLINE)

COURSE APPLIED FOR

Add Your
Photo

______________________________________________________________________

Name of the Applicant _____________________ _________________ ____________________


(in capital letters)

(First Name)

(Middle Name)

(Last Name)

Date of Birth
d
Gender

Male

Category

Open

Educational
Qualification

S.S.C

Residential

Female

SC

HSC

UG

ST

Graduate

DT/NT

PG

OBC

Other 's (Please Specify)

______________________________________________________________________________________________

Addresss
_________________________________________________________________________________________________
Tel No. Home : __________________
PRESENT QUALIFICATION :

Mobile : _________________ E-Mail : ____________________________________________


STUDENT

EMPLOYED

Currently Studying in

________________________________________________________________________________________

College/ Institute Name

________________________________________________________________________________________

College/ Institute Address ________________________________________________________________________________________


IF EMPLOYED
Name of the Company
or Organization
Designation
Additional Information
(If required)

________________________________________________________________________________________
_____________________________________ Tel No. Office _______________________________________
________________________________________________________________________________________

PAYMENT DETAILS
`________________ (In Words ________________________________________________________________________________)
DD. No.

_____________________ Dated __________________

Drawn On ___________________________________________________________
Branch

___________________________________________________________

Applicant Name

___________________________________________________________________________________________

(Printed on Certificate)

(in Capital Letters)

Date -_________________
I have read all the rules and regulations and agreed to abide it. If accepted for the course, I commit myself to regular and punctual
participation.

Signature of the Applicant


______________________________________________________________________________________________________________
INSTRUCTIONS

Fees once paid will not be refunded under no circumstances.

Course available through Online Learning Mode only and students are provided with Login ID and Password for access to e-learning
portal. Besides duration of the course, enrolled students are allowed to access the course for six months from the date of
registration and they can appear for online examination any time during this six months duration at our Churchgate Testing Centre .

100% attendance/credit hours is compulsory for the award of the certificate.

Discipline must be followed by all.

The Director has the right to discontinue a participant without giving any reason.

The Department will not be responsible for any damage to the certificate or loss of the certificate when it has been sent by post.

Revaluation of the test is not permitted.

Demand Draft should be drawn on THE FINANCE AND ACCOUNTS OFFICER, UNIVERSITY OF MUMBAI payable at Mumbai

Only Demand Draft (DD) will be accepted.

Application without Demand Draft will not be accepted. Completed application form along with the Demand Draft, Certificates and
Testimonials shall be submitted to the Director, DEPARTMENT OF LIFE LONG LEARNING AND EXTENSION, Vidyapeeth Vidyarthi
Bhavan, Second Floor, 'B' Road, Churchgate, Mumbai- 400020.

______________________________________________________________________________________________________________
S P A C E F O R O F F I C E U S E:

I recommend Mr. / Mrs. /Miss _________________________________________________ to attend the Course arranged by the Department
of Life Long Learning and Extension.

Place: ____________________
Date: ____________________
Signature of the Director/Stamp

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