APPLICATION FORM

1. Name of Course Applied.

2. Course Code.

Paste recent
3. Level of the Course PG UG PG Diploma Diploma Certificate Passport Size
Photograph. It will
be printed on I Card

4. Student’s Name

Email…………………………………………………………. Phone No.

5. Father’s Name

Occupation: …………………………………………………………………………………………………………………………………………………………………………..

Email……………………………………………………….…………………………. Phone No.

6. Mother’s Name

Occupation: ………………………………………………………………………………………………………………………………………………………..………………..

Email……………………………………………………….…………………………. Phone No.

7. Address for Correspondence ………………………………………………………………………………………………………………….…………………………..

................................................................................................................................................................................................

……………………………………………………………………………………………………………….………… Pin Code

8. Permanent Address ……………….. ……………………………………………………………………………………………..…………………………………………..

.................................................................................................................................................................................................

…………………………………………………………………………………………………………………………Pin Code
9. Date of Birth Date Month Year

10. Gender Male Female

11. Category GEN OBC SC ST MIN

12. Religion …………………………………………………………………..

13. State of Domicile. Uttarakhand Other Name of State ……………………………….

14. Nationality.

15. Aadhar no. (if any)

16. Annual Family Income ………………………………………………………………………………….

Details of the last Examination passed:-

Exam Passed Board/University Subject Marks Remarks
Obtained Marks Full Marks
10th / Matric

12th / Inter

Graduation

Post-
Graduation
Any Other

DECLARATION
1. That I have carefully gone through the above application form relating to admission and other particulars and filled in
the same by myself without being influenced by any Person/s.
2. That particular provided by me are true and correct to the best of my Knowledge, belief and information.
3. That my Registration may be withdrawn anytime by the University, in the event of my failure to submit the original
Migration form/Transfer certificate from the Board/University that I have last attended within the time as stipulated
by the University. (This declaration may be ignored, if the applicant has already submitted his/her in original
Migration/Transfer certificate with this Application).
4. That registration for the above mentioned course shall be in force only when tuition free paid by Draft/Cheque is
realized in University’s account.
5. That I shall not indulge in any act of Ragging and shall hold the dignity of my follow female students in particular and
all the elders & women in general the University campus in high esteemed.
6. That I shall keep the University campus clean free from all plastic, elements to save the environment.
7. That I, without recourse to any other means, shall apply for the necessary verification of my academic credentials
which may include certificates marksheets, Degrees, Diplomas etc. that I shall acquire from this University during my
period of studies or thereafter, any time, if needed, by submitting my application in prescribed format for the same
with requisite fee to be payable for the said purpose at such time.
……………………………………………
Signature of the Student (Applicant)

DECLARATION BY FATHER/GUARDIAN

I hereby declare that my ward ………………………………………………………. will not indulge in any act of ragging and shall not
cause or cause to do such act/s that may disturb the dignity of any person/s in the campus. Rules and regulation of the
university will be binding on my ward and me.
…………………………………………..
Signature of Father/Guardian

FOR OFFICE USE ONLY

Granted Waiting Rejected

Admission

Registration No. Receipt No.

Date of Admission Date Month Year Course code

Admission in-charge: Registrar

Registration No.

Course Code

Enrollment No.

C.C

Date: ………/……./………………….
Following self attested copies of document enclosing here with.

1. 10th mark sheet from recognized board

th
2. 12 mark sheet from recognized board
3. 10th pass certificate from recognized board
th
4. 12 pass certificate from recognized board
5. Graduation Marks Sheet
6. Post Graduation Marks Sheet
7. 4 passport size photographs
8. Aadhar card
9. Anti-ragging Affidavit
10. Domicile (for permanent residents of Uttarakhand) and for claiming Government facilities.
11. Annual income certificate
12. Transfer certificate / Migration Certificate (Original)
13. Character certificate
14. Proof of entitlement for a particular reservation category (SC/ST/OBC/MIN Certificate)
15. Pre-Qualifying test score card (If any)
16. Medical Fitness Certificate (In Case of any Medical History)
17. Domicile certificate
18. Caste certificate if claiming Government Scholarship
19. Bank account detail for scholarship
20. Copy of passport (for foreign student)
21. Equivalent certificate of foreign Degree/Diploma issued by AIU (Association of Indian Universities, New Delhi)