7/10/2019
STUDENT COPY
DR. HEGADEWAR PRATISHTHAN COLLEGE OF EDUCATION (5116A) Application No :
105, Kedgaon Devi RoadAhmednagar
Academic Year: 2019-2020 183091
YCMOU Study Center Submission Slip Distance Education
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 : Diploma in School Management(with Credits) - Distance Education - 2016 Pattern - Diploma in PRN:2013017000316283
School Management (P10)
Application Date : 10/07/2019
Exam Center Name [Code] : - [-]
1.Personal Information
Candidate's Name(Regional) :
Candidate's Name as printed on School PAKHARE GANESH SAKHARAM
leaving/Passing Certificate : [*This name will appear on all University records/documents]
Father's/Husband's Name : SAKHARAM PAKHARE Mother's Name : TARAMATI
Marital Status : UnMarried Mother Tongue :
Place Of Birth : PADALI Gender : Male Date of Birth (DD/MM/YYYY) : 09/07/1992
Blood Group : Religion : Country of Citizenship : India
Height : Not Available Weight : Not Available Hemoglobin : Not Available
Is Student NRI/ Foreign National : No Domicile State:
Address For Correspondence :
Location Area : Not
State : Maharashtra District : Beed Tehsil : Shirur (Kasar) City/Town/Village :
Available
Address (House
A/P 163/1 PADALI Pin Code : 413249
no,street/area/suburb etc.) :
Contact details
Mobile Number 919657122841 Email ID:
2.Legal Reservation Information
Category Type : Reserved Category : NT-3 (NT-D)
Is Specially Abled? No
3.Social Information(Additional Inforamtion)
Paper Selected for:
Diploma in School Management
EDU113 - Academic Management EDU114 - Office Management
EDU115 - School Financial Management EDU116 - School Building And Other Physical Amenities
EDU117 - Student Services Welfare And Quality Development Of Pupils EDU118 - Management Of Human Relation
EDU199 - Principal Of Management P10-RES - Action Research
Medium of Instruction : Marathi
Admission Fee Payment Details Payment Status : Paid Transaction Date : 10/07/2019
Transaction Number :
Fee Category : Regular Fees Transaction Type : Online Payment
1830911562756685885
Admission Late Fee - 100 Admission Super Late Fee - 500
Adm Exam Fee - 750 Tution Fee - 400
Registration Fee - 100 Development Fund Fee - 650
Other Fee - 200 Total : 2100
4.Guardian Information
Occupation of Guardian : Farmer Annual Income of Guardian : 45000
1/4
7/10/2019
5.Educational Details
Month
Name of Name of Board/University and Name of and Year Exam Seat Certificate Mark
Out Of CGPA %
Examination State of University School/College of No. No. Obtained
Passing
Std 12th 12th MADHYA PRADESH BOARD OF July
-- -- 1.00 1.00 -- - -- 100.00
(Science) SECONDARY EDUCATION, 2010
MAHARASHTRA STATE BOARD
SHRI TILOK JAIN
OF SECONDARY AND HIGHER June
Std 10th VIDYALAYA C134176 135918 585.00 650.00 -- - -- 90.00
SECONDARY 2008
PATHARDI
EDUCATION,Maharashtra
Certificate :
MAHAVEER
Bachelor of Arts Yashwantrao Chavan Maharashtra June
COLLEGE AG1574012 104234515 757.00 1200.00 -- - -- 63.08
- (B.A.) Open University,Maharashtra 2016
KOLHAPUR
(ENGLISH)
Certificate : SHIVAJIRAO
Bachelor In DESHMUKH
June
Education - Shivaji University,Maharashtra COLLEGE OF 1720 1328749 1593.00 2400.00 -- - -- 66.38
2018
(B.Ed.) EDUCATION
(ENGLISH) SHIRALA
Your Last Qualifying Exam: Bachelor In Education - (B.Ed.)
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 Application No :183091 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 )
For College/Institute/Study Center Use Only
Designation Remarks / Particulars / Recommendations Signature and Date
Admission Clerk
Admission
Committee
Accountant/Cashier Cash Received: Rs. Receipt No.: Date:
Registrar/Office
Superintendent
Document printed on Wed Jul 10 2019 11:08:58 GMT+0530 (India Standard Time)
2/4
7/10/2019
[STUDY CENTER COPY]
DR. HEGADEWAR PRATISHTHAN COLLEGE OF EDUCATION (5116A) Application No :
105, Kedgaon Devi RoadAhmednagar
Academic Year: 2019-2020 183091
YCMOU Study Center Submission Slip Distance Education
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 : Diploma in School Management(with Credits) - Distance Education - 2016 Pattern - Diploma in PRN:2013017000316283
School Management (P10)
Application Date : 10/07/2019
Exam Center Name [Code] : - [-]
1.Personal Information
Candidate's Name(Regional) :
Candidate's Name as printed on School PAKHARE GANESH SAKHARAM
leaving/Passing Certificate : [*This name will appear on all University records/documents]
Father's/Husband's Name : SAKHARAM PAKHARE Mother's Name : TARAMATI
Marital Status : UnMarried Mother Tongue :
Place Of Birth : PADALI Gender : Male Date of Birth (DD/MM/YYYY) : 09/07/1992
Blood Group : Religion : Country of Citizenship : India
Height : Not Available Weight : Not Available Hemoglobin : Not Available
Is Student NRI/ Foreign National : No Domicile State:
Address For Correspondence :
Location Area : Not
State : Maharashtra District : Beed Tehsil : Shirur (Kasar) City/Town/Village :
Available
Address (House
A/P 163/1 PADALI Pin Code : 413249
no,street/area/suburb etc.) :
Contact details
Mobile Number 919657122841 Email ID:
2.Legal Reservation Information
Category Type : Reserved Category : NT-3 (NT-D)
Is Specially Abled? No
3.Social Information(Additional Inforamtion)
Paper Selected for:
Diploma in School Management
EDU113 - Academic Management EDU114 - Office Management
EDU115 - School Financial Management EDU116 - School Building And Other Physical Amenities
EDU117 - Student Services Welfare And Quality Development Of Pupils EDU118 - Management Of Human Relation
EDU199 - Principal Of Management P10-RES - Action Research
Medium of Instruction : Marathi
Admission Fee Payment Details Payment Status : Paid Transaction Date : 10/07/2019
Transaction Number :
Fee Category : Regular Fees Transaction Type : Online Payment
1830911562756685885
Admission Late Fee - 100 Admission Super Late Fee - 500
Adm Exam Fee - 750 Tution Fee - 400
Registration Fee - 100 Development Fund Fee - 650
Other Fee - 200 Total : 2100
4.Guardian Information
Occupation of Guardian : Farmer Annual Income of Guardian : 45000
3/4
7/10/2019
5.Educational Details
Month
Name of Name of Board/University and Name of and Year Exam Seat Certificate Mark
Out Of CGPA %
Examination State of University School/College of No. No. Obtained
Passing
Std 12th 12th MADHYA PRADESH BOARD OF July
-- -- 1.00 1.00 -- - -- 100.00
(Science) SECONDARY EDUCATION, 2010
MAHARASHTRA STATE BOARD
SHRI TILOK JAIN
OF SECONDARY AND HIGHER June
Std 10th VIDYALAYA C134176 135918 585.00 650.00 -- - -- 90.00
SECONDARY 2008
PATHARDI
EDUCATION,Maharashtra
Certificate :
MAHAVEER
Bachelor of Arts Yashwantrao Chavan Maharashtra June
COLLEGE AG1574012 104234515 757.00 1200.00 -- - -- 63.08
- (B.A.) Open University,Maharashtra 2016
KOLHAPUR
(ENGLISH)
Certificate : SHIVAJIRAO
Bachelor In DESHMUKH
June
Education - Shivaji University,Maharashtra COLLEGE OF 1720 1328749 1593.00 2400.00 -- - -- 66.38
2018
(B.Ed.) EDUCATION
(ENGLISH) SHIRALA
Your Last Qualifying Exam: Bachelor In Education - (B.Ed.)
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 Application No :183091 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 )
For College/Institute/Study Center Use Only
Designation Remarks / Particulars / Recommendations Signature and Date
Admission Clerk
Admission
Committee
Accountant/Cashier Cash Received: Rs. Receipt No.: Date:
Registrar/Office
Superintendent
Document printed on Wed Jul 10 2019 11:08:58 GMT+0530 (India Standard Time)
4/4
