Jamalpur Mahavidyalaya
Jamalpur, Burdwan, Pin: 713408
1111111111  1111111111

Application Form - Certificate Course in Yoga
Maximum Photo Size 30KB
Maximum Signature Size 20KB
Applicant Name(Block Letter) :
Gender :
Blood group :
Mother's Name :
Father's Name :
Category :
Do you belong to Physically Challenged category? :
Nationality :
Date of Birth :

Are you a student of Jamalpur Mahavidyalaya at present?

Are you a student of Jamalpur Mahavidyalaya at present?
If yes then Section :
Department :
Semester :
Class Rollno :

Contact Details
Whatsapp No. :
Contact No. :
Email Id :

Permanent Address Details
House No.& Street:
Village/Town/Society:
Post Office/City:
District:
State:
Pincode:

Previous Examination Details(12th/+2 & Others)
Examination
Passed		 Board/Council
University		 Registration No.
with Year		 Year of
Passing		 Marks
Obtained		 Total
Maximum Marks		 Percentage Division/
Class

Last Institution attended with address :
Institution:
Address:
Why you are interested in this course?
I agree to pay the course fee(Rs. 3500.00)in full at the time of admission. I know that the admission fee is non-refundable. I also hereby declare that the information given here are true and if found false my candidature may be cancelled.
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