KALAHANDI UNIVERSITY

Manikya Vihar
Bhawanipatna(Kalahandi)-766001 Odisha

HOSTEL ADMISSION FORM

Hostel Name: Nagawali Women’s Hostel/ Udanti Women’s Hostel/
Bansadhara Boys’ Hostel/ West Boys’ Hostel
STUDENT’S
STUDENT INFORMATION (in Block Letters)
RECENT
1. NAME: _______________________________________________________ PHOTO

2. AADHAR NUMBER: ____________________________________________

VOTER ID: ___________________ PASSPORT NO.:__________________

BLOOD GROUP:
3. PROGRAMME: __________________ SESSION: ____________________
O +ve / O –ve
4. ROLL NO.:_______________________ D.O.B: ______________________ A +ve / A –ve

5. MOTHER’S NAME: ____________________________________________ B +ve / B –ve

AB +ve / AB –ve
6. FATHER’S NAME: _____________________________________________
Put a tick mark.
7. NAME OF THE LAST INSTITUTION ATTENDED:
Sufferings if any:
______________________________________________________________ ________________
________________
8. WHETHER AN ALUMNI OF LAST ATTENDED INSTITUTION: (YES/NO) ________________
9. CONTACT NO. OF THE STUDENT: ______________________________
Whether a member of
10. CONTACT NO. OF THE MOTHER/ FATHER: ______________________ NCC (Army/ Navy/
Air) / NSS/YRC/ Self
Defence or Any other
11. EMAIL Id: ____________________________________________________ activity group.
------------------------
12. VEG/ NON-VEG: _______________________________________________ -----------------------

13. PRESENT ADDRESS: ___________________________________________ Interest Areas:

 Debating
_____________________________________________________________  Blood Donation
 Plantation
_____________________________________________________________  Sports
 Cultural (Song/
14. PERMANENT ADDRESS: ________________________________________ Dance/ Drama)
 Mountaineering
_____________________________________________________________  Any other
______________
_____________________________________________________________ ___
15. NAME & ADDRESS OF LOCAL GUARDIAN: ______________________ If selected in Earn
While You Learn
_______________________________________________________________ Scheme (Yes/ No)
Date:
___________________________________PHONE NO.:_________________ Time:
Work:
16. OCUPATION/ DESIGNATION OF

i) MOTHER:_____________________________
ii) FATHER: _____________________________
iii) LOCAL GUARDIAN: ___________________
17. NAME OF RELATIVES/ VISITORS WITH ADDRESS & PHONE NO (OTHER THAN PARENTS/
LOCAL GUARDIAN):
i) ___________________________________________________________________________

ii) ___________________________________________________________________________

iii) ___________________________________________________________________________

18. EXTRA CURRICULAR ACHIEVEMENTS/ ACTIVITIES: _______________________________

_______________________________________________________________________________

19. ARTICLES/ BOOKS PUBLISHED (If any) : ___________________________________________

_________________________________________________________________________________

20. ACTIVITIES DONE FOR THE SOCIETY/ ENVIRONMENT: _____________________________

________________________________________________________________________________

RULES FOR HOSTELLER

a. All residents of the hostel are required to follow the hostel rules and regulations.
b. Allotment of rooms is solely at the discretion of the administration
c. Hostel residents will be solely responsible for any offence or casualty caused to individuals
inside or outside the campus
d. The rooms shall be open to inspection by the Hostel Warden / Management, any time.
e. Students are required to be in the hostel premises after 07 pm for Boys and 6 pm for Girls
unless otherwise specifically allowed.
f. The use electric appliances except computer/laptops are banned in the hostel.
g. Students are not permitted to keep any type of music system (Extra speakers/woofers) in their
rooms.
h. Parties of all nature are banned in the hostel premises (Specifically ‘Birth Day Party’ at night)
i. During the class timings students are expected to attend all the classes regularly & punctually
j. If any day-scholar is found to be present in the hostel in the collusion with the hosteller, the
former will be suspended from the university and the latter will be suspended from both the
hostel and the university. Also no family members are allowed to enter the rooms.
k. Residents should take all their meals in the Dining Hall of the Mess only.
l. Residents will be served meals only during the prescribed timings.
m. There will be a common menu for all the residents.
n. Residents should not carry their meals wholly or in part outside the Mess to their rooms.
o. Residents should be properly dressed for the Mess.
p. Residents should not interfere with cooking or other services and shall not meddle with the
Mess equipment.
q. Residents should cooperate with the Mess employees and deal with them in a polite and
courteous manner.
r. Residents shall not go outside their rooms after Roll Call at night till 6:00 AM next morning
without the written permission.
 s. Residents shall clear their mess dues in monthly wise. Otherwise, will pay the fine which is
decided by hostel superintendent.
t. Students must obtain a “No Dues Certificate” from the ACCOUNTANT before leaving the
hostel at the end of the session.
u. Persons for online delivery are not allowed the hostel premises.

ACTION WOULD BE TAKEN AGAINST A HOSTELLER, WHICH MAY LEAD TO

THE CANCELLATION OF HIS /HER ALLOTMENT OF THE HOSTEL
ACCOMMODATION, IF:

a) Any sort of indiscipline/ misbehaviour/ threat to the smooth sail of the activities of the
University or Hostel will not be entertained.
b) His / her stay in the Hostel is found to be not congenial to the Hostel atmosphere.
c) A criminal charge is registered or an FIR has been lodged / an enquiry is in progress against
him / her.
d) He / she has been a habitual defaulter in making payment of dues.
e) He / she has been irregular in attending the class lectures and / or has failed to show good
performance in studies or has failed to appear at the examination / tests.
f) He / she has failed to vacate his/ her room immediately after his / her examination as required
under the rules or has not obtained the “No Dues Certificate” from the Accountant on leaving
the hostel after vacating the room.
g) He / she is found guilty of misbehaviour with the hostel employee(s) / fellow hostellers and has
failed to improve his / her conduct in spite of verbal / written warning by the hostel
administration.
h) He / she is found stealing or damaging hostel property like electric bulbs, tube-lights, curtains,
utensils, etc.
i) He / she is found involved in other illegal activities including gambling, gherao and making
noise etc.
j) Cancellation of admission in the college would mean cancellation of hostel accommodation
also
k) The use of intoxicants-alcohal, zarda, gutkha ,Smoking etc are strictly prohibited in the hostel
as well as university premises or in living room. No students will come to the hostel in an
inebriated condition.
l) IF HE/SHE IS FOUND INVOLVED IN RAGGING, HE/SHE WILL BE EXPELLED
FROM THE HOSTEL UNIVERSITY IMMEDIATELY.

m) LEAVING THE HOSTEL WITHOUT PROPER REPORTING MAY AMOUNT TO

CANCELLATION OF BOARDERSHIP INSTANTLY.

HOSTEL CHARGES
1. AT THE TIME OF ADMISSION – Rs 10000/- (including caution money Rs 3430 /- which is
refundable at the time of clearance)
2. AT THE TIME OF RE- ADMISSION – Rs 6570/-
N.B:-
i. AFTER COMPLETION OF ADMISSION THE AMOUNT WILL NOT BE
REFUNDED EXCEPT CAUTION MONEY.
ii. HOSTEL AND MESS CHARGES CAN BE REVISED ANY TIME WITHOUT PRIOR
INFORMATION, AND STUDENTS HAVE TO COMPLY WITH ACCORDINGLY.
IN THIS REGARD THE DECISION OF THE MANAGEMENT SHALL BE FINAL
AND BINDING.
 REQUIRED DOCUMENTS FOR ADMISSION

i. University Admission Silp (xerox copy)

ii. Hostel bed registration slip (Rs 60/- which is to be paid to university directly)
iii. Identity proof (Aadhar Card / Voter Id Card / or Any other which is approved by the Govt. of
India)
iv. Original payment slip (Rs 10000/- which is to be paid to the hostel establishment account)
v. Two Nos. of Passport size Photo of Student, Father, Mother, & Local guardian.
vi. One more passport size photograph of the student for Boarder Identity Card. ( The boarder
has to carry the identity card positively while coming out of the hostel)

DECLARTION BY THE APPLICANT:

1. I have carefully read and understood all the rules and regulations mentioned above. I will
follow the rules and regulations and subsequent changes/ additions, if any, as laid down by the
University/ Hostel.
2. I understand that a suitable action can be taken against me if I do not abide by the rules &
regulations of the Institute. If I leave the Hostel on my own or I am expelled from the Hostel
in the middle of the session, I will not be entitled to claim any refund.
3. I hereby undertake that if I stay outside the campus, I shall be doing it at my own risk and
responsibility and the University will not be responsible in any manner whatsoever (However,
I will not leave the hostel without proper information).
4. I hereby understand that if I am found involved in ragging in any manner, I will be expelled
from hostel and university immediately.
5. I will attend the classes/ different curricular and extra-curricular events/ use the
Library with utmost discipline; failing which my boardership may be cancelled.
Think No Evil

Full Signature of Applicant

Fourth Monkey
© Sanjay Kumar Satapathy
PHOTO OF MOTHER PHOTO OF FATHER PHOTO OF LOCAL
GUARDIAN

Signature of Father Signature of Mother Signature of local Guardian