Kushabhau Thakre Patrakarita Avam Jansanchar Vishwavidyalaya

ONLINE APPLICATION FORM

1. Course Applied For:
2. Name:
3. Father's Name:
4. Mother's Name:
5. Full Address:
	City: State: Pin:
6. Email:
7. Phone No. (with std code)
8. Gender:	( Male / Female )
9. Date of Birth:	( dd/mm/yyyy )
10.Category:	( General / SC / ST / OBC / Handicapped )
11. Educational Qualification

12. Extra Curricular Activities
1

1

Candidates filling the form Online must send a DD of Rs. 250 (Rs. 100 in case of SC/ST candidates of Chhattisgarh) drawn in favor of "Registrar, Kushabhau Thakre Patrakarita Avam Jansanchar Vishwavidyalaya, Raipur" payable at Raipur (Chhattisgarh) along with 2 passport size photograph within a week time. Also write your all the details such as ID No., Name, Father's Name, Full Address in back side of DD.