Symbiosis Letter
Centre for Distance Learning (SCDL)
SYMBIOSIS
Symbiosis Bhavan, 1065 B, Gokhale Cross Road, Model Colony, Pune -- 411016, Maharashtra, India. Tel. 020 66211000 I Fax: 020 66211040 I 41 I www.scdl.net
Please read the instructions before filling the form Application Form For Admission 2011 Application No. 27274
To, The Director, I request for grant of admission to the below mentioned program being offered by your institute for the academic year starting from July 2011.
A Personal Details
(IN BLOCK LETTERS)
Name of the applicant should be as per Degree /
Paste one recent passport size colour photo & attach another photo at the top right corner
Diploma Certificate attached / Diploma Certificate attached. In case of name change, attach the required document.)
Last Name: First Name: Middle Name: Date of Birth: dd mm yyyy Gender: Male Female
(IN BLOCK LETTERS) Please use spaces and / or commas wherever applicable. B Address (Students should take utmost care in writing complete address so as to receive all commmunication, Study kit, ID Communication Address: on this address without any delay. Re-dispatch due to incorrect address will be at an extra cost to be paid by the student.)
Address:
Taluka: City: Country: Tel. No: Email: State:
District:
Pin Code: Mobile No:
(Ensure your contact no. is correctly recorded as SCDL sends important messages via SMS. Any change in Address / Contact No. / Email must be communicated to SCDL immediately.)
Permanent Address: Address:
Taluka: City: Country: Tel. No: Email: State:
District:
Pin Code: Mobile No:
(Signature of Applicant)
1 of 5
Are you an active student of SCDL? If yes please write your registration no. C Student Category Defence Para - Military General / Civil International Student
D Programs
Police Symbiosis Employee / Staff
SAARC Countries
Category 1
Tick the appropriate Program / Course. Student can register for only one PG program at a time.
SYMBIOSIS
Symbiosis Bhavan, 1065 B, Gokhale Cross Road, Model Colony, Pune -- 411016, Maharashtra, India. Tel. 020 66211000 I Fax: 020 66211040 I 41 I www.scdl.net
Please read the instructions before filling the form Application Form For Admission 2011 Application No. 27274
To, The Director, I request for grant of admission to the below mentioned program being offered by your institute for the academic year starting from July 2011.
A Personal Details
(IN BLOCK LETTERS)
Name of the applicant should be as per Degree /
Paste one recent passport size colour photo & attach another photo at the top right corner
Diploma Certificate attached / Diploma Certificate attached. In case of name change, attach the required document.)
Last Name: First Name: Middle Name: Date of Birth: dd mm yyyy Gender: Male Female
(IN BLOCK LETTERS) Please use spaces and / or commas wherever applicable. B Address (Students should take utmost care in writing complete address so as to receive all commmunication, Study kit, ID Communication Address: on this address without any delay. Re-dispatch due to incorrect address will be at an extra cost to be paid by the student.)
Address:
Taluka: City: Country: Tel. No: Email: State:
District:
Pin Code: Mobile No:
(Ensure your contact no. is correctly recorded as SCDL sends important messages via SMS. Any change in Address / Contact No. / Email must be communicated to SCDL immediately.)
Permanent Address: Address:
Taluka: City: Country: Tel. No: Email: State:
District:
Pin Code: Mobile No:
(Signature of Applicant)
1 of 5
Are you an active student of SCDL? If yes please write your registration no. C Student Category Defence Para - Military General / Civil International Student
D Programs
Police Symbiosis Employee / Staff
SAARC Countries
Category 1
Tick the appropriate Program / Course. Student can register for only one PG program at a time.