Application for Admission

Approved by UGC An ISO 9001:2008 Certified Institution

Note: Please read the form carefully before filling it.

Form No.

Fill the form in capital letters.

Attach the required documents (Xerox copy) as mentioned in educational qualification.

Attach the Result/Score/Rank of qualifying examination (if applicable).

JU/2012-

Registration No.
(to be given by the office)

1. Programme Applied For :

(for programme list see the Information Brochure)

2. Details of Qualifying Entrance Examination :

Name of Qualifying Examination

Month & Year

Score/Rank

Affix your recent

Passport size
photograph not
earlier than 6 month

3. Personal Details :

Name (Mr. / Ms.) :

DD

MM

YY

Date of Birth :
Category

(Years)

(M/F)

Age :
Nationality

Gender :

(Married/Unmarried)

Marital Status :

4. Contact Details :
Correspondence Address : .............................................................................................................................................................
.............................................................................................................................................. Pin Code :
Phone No : ......................................... Mobile No : .............................................. Mail ID : ..............................................................
Permanent Address : .......................................................................................................................................................................
.............................................................................................................................................. Pin Code :
Phone No : ................................................................................ Mobile No : .......................................................................................
5. Details of Contact Person Incase of Emergency
Name : ..................................................................................................................... Phone/Mobile No. : ...........................................
Address : .................................................................................................................................................................................................
..................................................................................................................................................................................................................
6. Parents Details :
Parents Name (Father & Mother)

Occupation

Phone No

Mobile No

Mail ID

7. Educational Qualifications:
Examination
Passed

Name of The
Stream

Name of the School / College

and Board / University

Year of
passing

Subject Studied

Marks Maximum % of
Obtained
Marks
Marks

10th
12th
Graduation
Post
Graduation
Any other
Qualification

8. Awards and Achievements (if any) :

.............................................................................................................................................................................................................
.............................................................................................................................................................................................................
.............................................................................................................................................................................................................
.............................................................................................................................................................................................................
9. Participation in Extracurricular Activities :
.............................................................................................................................................................................................................
.............................................................................................................................................................................................................
.............................................................................................................................................................................................................
.............................................................................................................................................................................................................
10. From where did you come to know about Jagan Nath University.
Newspaper

Radio/T.V.

Magazine

Friends/Family

Please specify the name of magazine / newspaper

Any other (Please specify) : ___________________________________________________________________________

11. Employment History :

Work Experience : Yes

No

(If, Yes Total Experience : Years ................................. Months ..................................

Organization / Company Detail :

Name of Company

Address

Duration

Designation

Nature of Work

Salary Drawn

12. Payment Details (applicable for downloaded forms only):

DD No.

DD Date

Amount

Name & Address of Bank

Declaration:
Jagan Nath University
Sir,
I wish to apply for admission to Jagan Nath University, Jaipur and promise to abide by the Rules & Regulations of the University. I certify that the
information given by me in this application form is correct and complete to the best of my knowledge and belief. I agree to be assigned for classes
to any of the campuses of the University in Jaipur without any prior notice. I understand and agree that misrepresentation, concealment or omission
of any fact will justify the denial or cancellation of my admission, or expulsion from the University. I further declare that I shall submit myself to the
disciplinary jurisdiction of the University.
I have read and understand all the terms and condition for the admission mentioned in the
prospectus and agree to abide by them.

Place: __________________

Date:___________________

Signature of the Applicant

Parents Declaration
I undertake that my son/daughter ________________________________________ applying for admission to __________________________________
course will be subjected to the University Disciplinary Rules and Regulation. I further undertake to pay
all the dues of the University in time.

Place: __________________

Signature of the Parent

Date:___________________

Admission
We recommended the applicant for provisional admission to _________________________________________________ after having verified his/her
original certificates and accept prescribed fees from the applicant. However, his/her admission is subject to the approval of the Governing Body of
the University.

Admission Incharge

Registrar

Form No.

Admit Card

JU/2012-

Approved by UGC
An ISO 9001:2008 Certified Institution

(Students Copy*)

(Helpline No.: 1800 1020 555)

Course Applied for :

Test Centre :

Date :

Name : Mr./Ms. _________________________________________________________________________

Date of Birth : __________________________________________________________________________
Fathers Name : Mr. ______________________________________________________________________
Address : _______________________________________________________________________________

Affix your recent

colour passport size
photograph

_________________________________________________________________ Pin Code

Ph. No. ____________________________________ Mobile No. _________________________________

Acknowledgement
*Kindly retain this copy for future use

Invigilators Signature

Specimen Signature
of the candidate
Turn back for Rules and Regulations

Chaksu Campus
Rampura, Chaksu, Jaipur-303901
Sitapura Campus
Plot No. IP - 2 & 3, Phase IV, Sitapura Industrial Area, Opp. Chokhi Dhani, Jaipur-302022
Contact No.
Phone: +91-141-3020500, 4071551
Fax: +91-141-3020538
E-Mail: [email protected]

www.jagannathuniversity.org

Rules & Regulations

Non-Refund of Fees

Attendance

The fees once paid are not refundable for any reason whatsoever.
Only Security Deposit will be refunded after making necessary
adjustments as required.

Minimum 75% attendance is compulsory to complete the course.

Cancellation of Admission
Jagan Nath University reserves its right to cancel the admission of
admitted student under any of the following circumstances:
If the fee is not deposited by the stipulated date.
If the candidate fails to join a particular programme by the
stipulated date, after the fee has been paid.
If the candidate fails to furnish the proof of the stipulated
minimum qualification.
If any student is found to be misbehaving or any other issue
regarding discipline at any point of time.

Jurisdiction
Any dispute pertaining to admission or any other matter concerning
a student or alumnus of Jagan Nath University shall be subject to
the jurisdiction of the Jaipur Court only.
Limitation Clause
No dispute shall be raised after the expiry of 30 days from the
date on which the process of admission and / or selection is
completed.
Agreement Clause
All admitted students shall be bound by the above mentioned Rules
& Regulations of Jagan Nath University.