SEICOM D.El.

Ed College
840/1, Rajuvari Palli, Kalikiri, Chittoor Phone No: 08586 202069,9440464521 _________________________________________________________________________________________

APPLICATION FOR ADMISSION INTO D.Ed., Course : 2013-14

The Application Process
Application could be obtained from the college office or downloaded from the college website www.seicom.weebly.com and filled in application submitted to the address given. The College requires each applicant to submit the documents listed below. It is your responsibility to ensure that the documents needed to complete your application are submitted in a timely fashion.

Admission Requirements:

Diploma in Teacher Education (DIET)

Should have qualified in 10+2 or equivalent examination. The eligibility criteria for admission is as per State Government Orders. Documents to be attached with the Application:
1. 2. 3. 4. 5. 6. 7. Application in the prescribed proforma (Collected from Administrative Office / website) Original copy of the SSC Examination, Bonafide Certificate / Study Certificate(s) (I to XII). Original copy of the Intermediate or Equivalent Exam. Original copy of the Transfer Certificate Original copy of the Hall Ticket and Rank Card of DIETCET Passport size photographs (5). 3 sets of Xerox copies of all certificates mentioned above.

Application should be submitted to:

The Principal SEICOM D.El.Ed College, 840/1,Rajuvari Palli, Kalikiri, Chittoor Dt. A.P Phone No: 08586 202069,9440464521 Web address : www.seicom.weebly.com Email address : seicom1997@gmail.com

SEICOM D.El.Ed College

840/1, Rajuvari Palli, Kalikiri, Chittoor Phone No: 08586 202069,9440464521 ______________________________________________________________________________________

Affix Passport Size Photograph

APPLICATION FORM FOR ADMISSION INTO D.Ed. COURSE 1. NAME IN FULL WITH CAPITAL LETTERS (As per SSC / Matriculation Certificate) 2. COURSE APPLIED FOR YEAR

3. DETAILS OF ENTRANCE TEST APPEARED: DIET

DIETCET - 2013

4. Hall Ticket No:

Marks Secured

Rank
EXAM
DIVISION

5. DETAILS OF QUALIFYING EXAMINATION - INTERMEDIATE /EQUIVALENT 6. TOTAL MARKS SECURED

OUT OF %

7. TOTAL MARKS SECURED IN OPTIONAL SUBJECTS (IN INTERMEDIATE)

OUT OF

TO BE FILLED BY THE APPLICANT

1. Name in Full with Capital Letters 2. Sex (Male/Female) 3. Date of Birth : Mr / Ms : :

(As recorded in SSC / Matriculation Certificate) 4. Identification Marks : (a) : (b) : : : : : : : Religion: : : YES / NO Mother Tongue : Sub-Caste :

5. Fathers Name 6. Guardians Name 7. Occupation of Father / Guardian 8. Name of the Mother 9. Occupation of Mother 10. Total Annual Parental Income 11. Place of Birth and Native Place 12. Nationality :

13. Category OC /EBC/BC(A/B/C/D/E) / SC/ST 14. Are you domiciled in AP

If answer is NO Furnish details of places of Your stay during the last 10 years

S.No.

Place of Stay
From

Period
To

Total Stay

15. Details of Education : (From 1st Standard Onwards)

Name of the School / College

Place

Classes
From To

Academic Years

16. Details of Examination Passed (From X Class onwards)

Examination X Class XII Class / Intermediate Year of Passing Board / University Total Marks Secured Percentage of Marks Class / Division Subjects / Group

17. Do you belong to NCC / SPORTSMEN / CAP (Defence) / PH Categories. If the answer is YES give details and enclose Certificate(s) in Original in Support thereof . YES / No Category 18. Have you participated in any Games and Sports at International / National / State / University / College Level? If so give details, indicate Position Secured and enclose Supporting Certificates.

19. Any other information you would like to furnish:

20. Address: Present / Local Permanent Address for Correspondence with Parents / Guardian ______________ ___________________ ______________________________ _________________ __ ___________________ ______________________________ ___________________ ___________________ _____________________________ Contact No. Land line : ___________________ ______________________________ Mobile / Cell Phone (Father): ___________________ ______________________________ Mobile / Cell Phone (Mother) : __________________ ______________________________ Mobile / Cell Phone (Student) : __________________ ______________________________ E-mail ID :__________________ _____________________________ DECLARATION BY THE APPLICANT I hereby apply for admission into D.Ed., course as per the details mentioned above. I confirm that the information furnished by me above is true to the best of my knowledge and belief. If found false. I shall forfeit my admission and all fees paid. Further. I shall abide by all the rules & regulations framed from time to time by the College and the State and I shall not indulge in any activity detrimental to the Societys objectives. I will not involve in any ragging activities and may be punished as per the rules in vogues, incase, I indulge in activities falling under the Category of ragging in any manner.

Signature of the Applicant

Date:

Name:

1.

2. 3.

4. 5.

UNDERTAKING BY THE CANDIDATE I, S/o, D/o of Mr./Mrs./Ms. have carefully read and fully understood the law prohibiting ragging and the directions of the Supreme Court and the Central / State Government in this regard. I have received a copy of the NCTE Regulations on Curbing the Menace of Ragging in Higher Educational Institutions, 2009 and have carefully gone through it. I hereby undertake that I will not indulge in any behaviour or act that may come under the definition of ragging. I will not participate in or abet or propagate ragging in any form. I will not hurt anyone physically or psychologically or cause any other from. I hereby agree that if found guilty of any aspect of ragging, I may be punished as per the provision of the NCTE Regulations mentioned above and / or as per the law in force. I hereby affirm that I have not been expelled or debarred from admission by any institution. Signed this .... day of ..month of year

Name:

Address:

UNDERTAKING BY THE PARENT / GUARDIAN

1. I, .......................................... F/o. M/o, G/o of ... have carefully read and fully understood the law prohibiting ragging and the directions of the Supreme Ragging in Higher Educational Institutions, 2009 2. I assure that my Son / Daughter / ward will not indulge in any act of ragging. 3. 3. I hereby agree that if He / She is found guilty of any aspect of ragging, He /She may be punished as per the provisions of the NCTE Regulations mentioned above as per the law in force. Signed this day of .. month of year Name : Address : Court and the Central / State Government in this regard as well as the NCTE Regulations Curbing the Menace of

Signature

(For Office Use)

Application No. : Fees particulars : Amount paid Rs.: DD No. / Cash Receipt No.

Admission Category : COUNCELLING / MNGMT QUOTA

Admission Slip Sl.No. Date : Date : Entered in Admin. Register Date : Date :

A.O. / Clerk

SEICOM D.El.Ed College

840/1, Rajuvari Palli, Kalikiri, Chittoor Phone No: 08586 202069,9440464521

_______________________________________________________________________________________

UNDERTAKING TO BE FILLED IN AND SIGNED BY ALL STUDENTS (NEW ADMITTED AND CONTINUING) I, ________________________________________________________________ (name of the student) studying ____________________________________ (Year, Degree / Course, section), at ________________________________________________ (Name of the College), S/o/D/o_________________________________________________________ Residing at ___________________________________________________________, (Permanent Home Address with Phone Number), undertake that I am aware of the system of punishment in case of ragging other student. In case I found involved in any manner in any form of ragging case I am liable for any punishment, including: 1. Cancellation of admission. 2. Suspension from attending classes. 3.Withholding / withdrawing scholarship/fellowship and other benefits. 4. Debarring from appearing for any test/examination or other evaluation process. 5. Withholding results. 6. Debarring from representing the institution in any national or international meet, tournament, youth festival etc., 7. Suspension, expulsion from the hostel. 8. Rustication from the institution for periods varying from 1 to 2 academic years. 9. Expulsion from the Institution and consequent debarring from admission to any other Institution. 10. Fine upto Rs. 10,000/11. Rigorous imprisonment up to three years (by Court of Law) etc.,

Date: ______________

Signature of the Student