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Convocation Application Form 2018

This document is an application form for candidates seeking to attend or receive their degree certificate from the convocation ceremony at SRI SIDDHARTHA ACADEMY OF HIGHER EDUCATION. The form requests information such as the candidate's name, date of birth, gender, degree program, registration number, and details of previous examinations. It also requires the candidate to submit documents like mark sheets and photos, and provide payment details if applicable fees have been paid. Instructions are provided for correctly filling the form and notes on attendance requirements and deadlines.

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Santosh Patil
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© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
49 views

Convocation Application Form 2018

This document is an application form for candidates seeking to attend or receive their degree certificate from the convocation ceremony at SRI SIDDHARTHA ACADEMY OF HIGHER EDUCATION. The form requests information such as the candidate's name, date of birth, gender, degree program, registration number, and details of previous examinations. It also requires the candidate to submit documents like mark sheets and photos, and provide payment details if applicable fees have been paid. Instructions are provided for correctly filling the form and notes on attendance requirements and deadlines.

Uploaded by

Santosh Patil
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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SRI SIDDHARTHA ACADEMY OF HIGHER EDUCATION

(Declared as Deemed to be University u/s 3 of the UGC Act, 1956)


Accredited ‘A’ Grade by NAAC Affix attested
recent colour
Agalakote, B.H.Road, Tumkur – 572 107.KARNATAKA, INDIA. passport size
Ph. 0816- 2275514 Fax: 0816-2275510, website: sahetumkur.ac.in email: [email protected] photo here

APPLICATION FOR ADMISSION TO THE CONVOCATION – 20…….


(To be sent to the Academy through the College)

IN-PERSON IN ABSENTIA
(Please tick any one of the above. This is only for
collection at the time of “Convocation -20……..... function”
To be filled in & sent to the Principal/s of the
respective constituent colleges of SSAHE on or before the
due date.
Degree for which the application made

…………………………………………………….
Name of the Candidate in full
1
(in capitals as registered in the Academy)

2 Date of Birth :

3 Gender : Male Female

4 Father’s Name :
5 Nationality :

Permanent Address in block letters with PIN :


6
code (to which certificate may be sent)

7 Mobile No. :
Examination passed with details [with : Final Exam Reg. No. Month Year
8 branch if any] (Attested copies of marks card of all
the Academy examinations should be enclosed)
Date of completion of Internship : From date: To date:
9
(if Prescribed)
Yes / No
Whether passed lower examination after passing
10 Final Year Passed year & month :
final examination? Submit details if yes.
Lower exam passed year & month :
11 College from which appeared :
Challan No./ DD No. Amount:
Whether the prescribed fee has been:
remitted? If so furnish details. If paid while
12 Date:
paying the final examination fee, the photocopy of
the bank challan to be enclosed.
Bank:
Aadhar Number
13
( a photo copy of aadhar to be enclosed)

Contd…2
-2 –

Furnish the following documents


a) All marks cards of……………………….. : Enclosed / Not Enclosed
b) Internship / Training Certificate : Enclosed / Not Enclosed
14
c) Fee details : Enclosed / Not Enclosed
d) 2 Recent Colour passport size photos : Enclosed / / Not Enclosed
f). Photo copy of Aadhar : Enclosed / Not Enclosed
Certified that the details and information furnished above are true & correct.

Place:
Date: Signature of the Candidate

The information furnished by the candidate as above and Sl. No. 14 is correct as per
the records maintained in the college.

Place:
Date: Signature of the Principal with Seal

Instructions to the Candidate


1. Candidates should write their name (in capital letters) legibly as registered for the Academy
examination
2. Self attested copies of marks cards of all the examinations should be enclosed
3. Candidate should write their optional / electives / Specializations clearly in the applications.
4. Ph.D candidates should enclose a copy of declaration of results and mention their titles of the
thesis legibly.
5. Candidate should writer their name and postal address legibly in the columns provided for in
the application.
6. The prescribed fee (in Rupees) for the degree certificate are as follows:
In person In Absentia (by Post)
Indian (Rs.) Indian (Rs.)
A. Under Graduate (Medical & Dental) 3000 3500
B. Post Graduate Diploma (Medical) 3500 4000
C. Post Graduate Degree (Medical & Dental) 5500 6000
D. Under Graduate (Engineering) 3000 3500
E. Post Graduate Degree (M.Tech & MCA) 3000 3500
F. Ph.D / M.Sc (Engg). 8000 8500
(Demand Draft in favour of “ Registrar, SSAHE”, Payable at Tumkur, Karnataka)
7. Two copies of recent colour passport size photographs of the candidate to be sent:
a) One copy duly attested and affixed to the application
b) The name & Reg. No. of the candidate, faculty and the college should be clearly
mentioned on the back of the other photo and to be put in separate cover & stapled
to the application.
8. Prescribed fees once paid will not be refunded or adjusted for future convocations.
9. No application will be accepted after the due date.
10. No application will be accepted directly in the Academy.
11. Incomplete and incorrect applications will be summarily rejected and no
correspondence will be entertained in the matter.
12. ‘In person’ means that the candidate has to be present himself/ herself physically at the
time of convocation to receive the Degree/ Diploma. ‘In Absentia’ means that the presence
of the candidate at the time of convocation is not required and the Degree / Diploma
certificate will be sent by Registered post after the convocation.

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