Rs.

500/-

KAKATIYA UNIVERSITY
SCHOOL OF DISTANCE LEARNING AND CONTINUING EDUCATION
WARANGAL 506 009 TELANGANA, INDIA

Application for B.Ed. (Distance Mode) 2014-2015

Affix recent
passport size
photograph

Note : The candidate should go through the Prospectus-cum-Application form for

Instructions before filling this application form in English
1.

Name of the Candidate

(in capital letters)

2.

Fathers Name

3.

Mother s Name

4.

Date of Birth

5.

D.D./ Challan : . . . . . . . . . . . . . . . . . .

Date : . . . . . . . . . . . . . . . . . . . . . . . ..
6.

ST

BC-A

Amount : . . . . . . . . . . . . . . . . . . . . . . .
Bank : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BC-B

Residential status (Put a mark)

9.

Gender (put a mark

10.

Name of the qualifying

examination passed
(Put a mark)

BC-C

Male

BC-D

Local

B.Sc.

B.Com.

Pin Code:
email

PH

Others

METHODOLOGY

Address for Communication

(in Block letters)

OC

Non-local

Female

B.A.

BC-E

Write Methodology

Mobile :

7. Others

8.

12.

(Put a mark)
SC

11.

Others

13.

Particulars of Employment:
Name of the School

Designation

Period of Service
From
To

Days

Months

School

Years

14.

Total length of Service as on 30-04-2015

15.

Particulars of study of preceding seven (7) years starting from the qualifying examination.
Name of the Institution / School / College

Qualification Year of Pass Percentage of Marks

S.S.C.
INTER
TTC/D.Ed.
DEGREE
OTHERS

I hereby solemnly affirm that the above information is correct and I am aware that my admission is liable to
be cancelled in case any information is found to be incorrect. I have gone through and understood the Rules,
Regulations and Instructions for admission into B.Ed. (Distance Mode) Programme offered by SDLCE, Kakatiya
University, Warangal

Date :

Signature of the Candidate

Signature of the Head of Institution

(Headmaster / Headmistress)

Clerk

Co-ordinator

DIRECTOR