Application For YCMOU - 2008

All fields marked * are mandatory.
 
Registration No.   FORM165           Note this number for further communication
Select a Programme
First Name* Middle Name* Last name*
Date of Birth * [dd/mm/yyyy; eg. 21/09/1977] Age
Gender
Marital Status
Nationality
Email* Mobile*
Address for
Correspondence*
City Pin State
Country
Phone*
Occupation of Parents
Father

Father's Occupation Annual Income (approx.)
Mother
Mother's Occupation Annual Income (approx.)
Guardian
Guardian's Occupation Annual Income (approx.)
Details of Institution where studied, exam passed and details of marks
SSC (Std. X)  
  Year of Passing*
  Name of School/College Name of Board/University
  Maximum Marks Marks Obtained*
  Total Percentage Percentage in English
HSC (Std. XII)  
  Year of Passing *
  Name of School/College Name of Board/University
  Maximum Marks Marks Obtained*
  Total Percentage Percentage in English
Graduation  
  Year of Passing * Name of Board/University
  Name of School/College
  Maximum Marks Marks Obtained*
  Total Percentage % and Percentage in English %

Details of Institution where studied, exam passed and details of marks

Work Experience

In Years


For further information, contact mitcom@mitpune.com