Office of Academic Registrations

Certificate Course Registration Form

Academic Year: 2016-17 Date :

Details of the Student

Register Number of Name of the
Student Student:

Branch Semester
List of Certificate Sports/Yoga Course-1 Course-2 Course-3
Courses already
completed
Details of Certificate Course and Fees
Name of the
Name of the Certificate
Conducting
course willing to register
Department
Name of Certificate Registration Fee in
Course Coordinator Rs.:
DU Number/DD Date of Fee
Number Payment:

Name of the Bank Name of the Branch

Remarks (if any)

Note:

1. This filled application should be submitted to the parent department along with online
payment receipt /DD.
2. Academic Regulation for B.Tech Y15 batch: Must successfully complete three (3)
certificate courses (four (4) in case of CSE students) in discipline domain areas, in addition to
yoga / sports & games / fine arts.
3. Academic Regulation for B.Tech Y14 & 13 batch: Must successfully complete two (2)
certificate courses in discipline domain areas, in addition to yoga / sports & games / fine arts.

SIGN of STUDENT with Date SIGN of HOD with Date