Centre for Distance and Virtual Learning, University of Hyderabad

Fields marked with * are compulsory

Pay Mode: *

Online Ref No.: *

Online Payment Date: *

Year:

2022

Program(Ist Choice): *

Category: *

Date of Birth: *

Gender: *

M F

Name: *

Father's Name: *

Mother's Name:

Nationality: *

Correspondence Address: *

City: *

Pin Code: *

Permanent Address

City:

Pin Code:

Phone:

Mobile No: *

Email Id: *

Aadhar No.: *

Indian Domicile State: *

Marital Status:

Married Un-Married

Resident Status: *

Annual income of the family (If SC/ST/PH )Rs.:

Identification Marks :

Mark 1:

Mark 2:

In case You fail to secure admission to the programme you have applied for, indicate a second Choice: *

Academic Details

Job Details

Job Status

If Yes Enter The following Details

Designation	Organization	From	To

Declaration By Student *

I hereby declare that all the information furnished by me in this application and in the documents I have submitted in support of my application are true, complete and correct to the best of my knowledge and belief.