UNI VERSI TY OF MADRAS

I NSTI TUTE OF DI STANCE EDUCATI ON

NrHf;if tpz;zg;gg; gbtk; NrHf;if tpz;zg;gg; gbtk; NrHf;if tpz;zg;gg; gbtk; NrHf;if tpz;zg;gg; gbtk; NrHf;if tpz;zg;gg; gbtk; /APPLICATION FOR ADMISSION
B.L.I.S. & M.L.I.S. COURSES - 2014-2015
CERTIFICATE COURSE / DIPLOMA COURSE - 2014-2015
ENROLMENT NUMBER (to be assigned by the IDE office / Co-ordinator, Spot Admission Centre / Study Centre)
APPLICATION NUMBER
REGISTRATION FEE
B.L.I.S. & M.L.I.S. Courses Rs. 150 /-
Certificate Courses Rs. 100 /- Diploma Courses Rs. 150 /-
(Payment should be made either by designated Bank Challan / Demand Draft)
CANDIDATE TO FURNISH ALL THE REQUIRED PARTICULARS BELOW IN CAPITAL LETTERS
BL I S/ML I S/ BL I S/ML I S/ BL I S/ML I S/ BL I S/ML I S/ BL I S/ML I S/
CE R/DI P CE R/DI P CE R/DI P CE R/DI P CE R/DI P
ACADEMIC YEAR 2014-2015
A 1 4
STUDY CENTRE / SPOT ADMISSION CENTRE
AT WHICH ADMISSION IS MADE
Centre Code Place
Recent Passport
Photograph signed by a
Gazetted Officer /
PRO/AR (IDE) /
Faculty with Seal
ADDRESS FOR COMMUNICATION (WRITE IN CAPITAL LETTERS)
NAME :
S/o, D/o, W/o, C/o. :
Door No. & Street :
Town / Village Post :
District :
State : INDIA
Pin code :
Phone (Res) : Off.
Registered Mobile No.(RMN) : E-Mail
PERSONAL CONTACT PROGRAMME CENTRE
PCP Centre Code Place
6. a) Community (Tick )
1. NAME OF THE APPLICANT
(as given in the certificate in
CAPITAL LETTERS)
8. Physically Challenged (Tick ) 9. Present Occupation
5. Religion (b) Age (c) Sex (Tick ) 4. Nationality
7. Mother Tongue
Yes

No
OC

/ BC

/ MBC

/ SC

/ ST
Male

/ Female
2. Name of Father / Mother /
Guardian / Husband
3. (a) Date of Birth as per Christian era
b) Caste
(a) in English
(b) in Tamil
Name of the Certificate Course Applied for Name of the Diploma Course Applied for Medium (Tick

)
TAMIL

ENGLISH
Name of the Course applied for
[put a () in the appropriate box]
B.L.I.S. M.L.I.S. CERTIFICATE DIPLOMA P.G. DIPLOMA
Candidate to tick () any one of the appropriate boxes
for Tuition Fee Consession - (Refer to Page No. 17) Differently Abled Prisoner
10. Are you undergoing any other course in a College or
University? If so, Specify
11. The wards of Defence Personnel / Ex-Servicemen (a) Ward of Defence Service Personnel
should specify as : (b) Ward of Ex-Servicemen : Navy / Army / Air force.
12. DETAILS OF EXAMINATION PASSED
Examinations passed Name of the Month & Year of Registration Class with Maximum
with Subjects Passing Number Grade/Marks Marks
S.S.L.C. / 10
th
Std.
Strikeout whichever is not applicable
(State whether it is 10 Years or 11 Years Course)
P.U.C. / Higher Secondary
Strikeout whichever is not applicable
(State Whether it is One Year
or Two Years Course)
B.A. / B.Sc / B.Com / BLIS / BLS
Strikeout whichever is not applicable
(State Whether it is Two Years
or Three Years Course)
(The above statement must be attested by the same Gazetted Officer/Assistant Registrar/
Public Relation Officer (IDE) / Faculty who attested the Photograph)
Enclosures
(1) ....................................... (3) ................................................. (5) ..............................................
(2) ....................................... (4) ................................................. (6) ..............................................
I hereby declare that all the particulars given above are correct and I agree to abide by all the Rules and Regulations
of the University that are in force from time to time.
Station :
Date : SIGNATURE OF THE APPLICANT
FOR OFFICE USE ONLY
The Admission particulars furnished in the column No. 12 have been duly verified with Originals and the Candidate
is eligible for admission
VERIFYING STAFF
1. Admission / Cancellation Intimation sent on ........................................................
2. Certificates returned to the Candidate on ........................................................
(1) Statement of Marks (2) S.S.L.C Book (3) Conduct Certificate
(4) Birth Certificate (5) Transfer Certificate (6) ..............................
ASST. /ASST. SECTION OFFICER SECTION OFFICER ASSISTANT REGISTRAR
STUDY CENTRE / SPOT ADMISSION CENTRE / PARTICIPATORY INSTITUTIONS / TWINNING PROGRAMME CENTRE / OFFICE
Signature of the Centre Co-ordinator with Seal DIRECTOR
Received the Provisional admission intimation and all the originals submitted by me
SIGNATURE OF THE APPLICANT
WITH DATE
Board / University School / College
UNIVERSITY OF MADRAS
INSTITUTE OF DISTANCE EDUCATION
COMPUTER CODING SHEET
B.L.I.S. / M.L.I.S. / CERTIFICATE / DIPLOMA / PG DIPLOMA COURSES
2. Main Subject chosen
3. ENROLMENT NUMBER (to be assigned by the office)
4. Name of the Candidate (Write in Capital Letters) (a) in English (b) in the Regional Language
5. Name of Father / Guardian / Husband (Write in Capital Letters)
as per entry in the Transfer Certificate
6. Mothers Name (Write in Capital Letters)
7. Date of Birth
9. Address for communication (do not write your name here)
City Pincode
Phone : Registered Mobile No. (RMN) : E-Mail :
1. Course to which admission is sought (Tick () Appropriate Box)
ACADEMIC YEAR 2014-2015
A 1 4
Date Month Year
8. Sex Male

Female

(a)
(b)
P.G. DIPLOMA
B.L.I.S. M.L.I.S
CERTIFICATE
DIPLOMA
10. Nationality Indian

Others 11. Region Urban

Rural
12. Religion
13. Caste
14. Community SC

ST

MBC

BC

OC
15. Physically challenged YES NO
16. Are you Employed? YES NO
17. Centre at which you propose to attend
the Personal Contact Programme classes
18. Centre at which you propose to collect the
study materials (Refer Page No. 48 to 56)
19. Are you a ward of a Defence Service
Personnel? (Army / Navy / Air Force)
20. Are you a ward of an Ex-service person? Yes No
21. Tuition Fee Concession Opted ?
(Candidate to tick (

) any one of the appropriate boxes -

Refer Page No. 17)
Station :
Date : Signature of the Candidate
Name
Code No.
Name
Code No.
Yes
No
Category
Affix
Passport Size
Photo
Not to be attested
Admission of Candidates from Other States
Candidates from other states should submit their applications at any one of
the Study Centres of the Institute of Distance Education (IDE), University
of Madras listed in the Prospectus, of the State concerned for admission to
various courses offered by IDE.
Applications received by post from the candidates of other States will
automatically be linked to the IDE Study Centre of the State concerned.
Applications received by post from the candidates of other States where there
is no Study Centre of this Institute (IDE), will be linked to the nearby IDE
Study Centre of the other State and candidates should undergo the courses
offered by this Institute through such allotted IDE Study Centre only.
Differently Abled
Prisoner
To be filled in by the applicant (6 copies of his/her address) and returned with the completed application form
(Please note that the admission intimation, original certificates and learning materials will be sent only to this address)
USE BALL POINT PEN ONLY. WRITE IN CAPITAL LETTERS
ADDRESS SLIP
B.L.I.S. / M.L.I.S / CERTIFICATE / DIPLOMA /
PG DIPLOMA COURSES
Affix
Passport Size
Photo
Not to be attested
Name : ...................................................................
................................................................................
Address : ................................................................
.................................................................................
.................................................................................
.Mob.No..............................................................................
PIN
Name : ...................................................................
................................................................................
Address : ................................................................
.................................................................................
.................................................................................
.Mob.No..............................................................................
PIN
Name : ...................................................................
................................................................................
Address : ................................................................
.................................................................................
.................................................................................
.Mob.No..............................................................................
PIN
Name : ...................................................................
................................................................................
Address : ................................................................
.................................................................................
.................................................................................
.Mob.No..............................................................................
PIN
Name : ...................................................................
................................................................................
Address : ................................................................
.................................................................................
.................................................................................
.Mob.No..............................................................................
PIN
Name : ...................................................................
................................................................................
Address : ................................................................
.................................................................................
.................................................................................
.Mob.No..............................................................................
PIN
Academic Year 2014 - 2015
A 1 4
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