(Garhwal), Uttarakhand - Hemwati Nandan Bahuguna Garhwal

Note: All Enteries are to be filled-in. Incomplete Apllication form will not be Entretained.
Form No. H/
Rs. 40.00
HEMWATI NANDAN BAHUGUNA GARHWAL UNIVERSITY
Srinagar (Garhwal), Uttarakhand
(A Central University)
The Photo
should be Attested
by the
warden/Chief
Warden
Instructions:- (a) Please attach the followings:
(i) Two Latest Photographs
(ii) Attested photo copy of the Residence proof ( Ration Card/Voter I.D./Driving Licence/Passport, etc.)
(iii) Attach attested Photo copies of all relevent documents.
(b) The admission will be valid for the current academic session only.
(c) Incorrect information may cause cancellation of admission.
1
Name of Student (in Capital Letters)
2
Mobile No. of Student & email
3
Father's Name
4
Mother's Name
5
Date of Birth (Day, Month, Year)
6
Class to Which Admitted
( state subject in case of Post Graduate &
Research Students)
7
Do you belong to SC/ST/OBC Category?
(if yes, attach photo copy of Certificate
issued by competent authority)
8
Permanent Address and
Phone No. of parents
9
Name and Address of Local Guardian
10 Local Guardians Phone No./Mobile/ e-mail
11 Address of Parents for Correspondence
(if different from Sl. No. 7 above)
(Phone No. /Fax/Mobile/ e-mail)
12 Blood Group of the Student
13 Details of the Medical Problems Suffered
by the Student (if any)
14 Are any Legal Proceedings Pending
against you in any Police Station/ Court of
Law (if yes, give details)
15 Date & No. of Receipt of Admission Fees
(Attach Photo copy of Receipt/ Registration
Certificate/Letter of guide)
16 Name of the Research Supervisor
(only for Research Scholars)
17 Were you allotted hostel earlier?
(if yes, indicate the details)
Year
Room No. & Name of the Hostel
18. Details of Educational Qualifications:
(Attach attested copies of Mark Sheets)
S.
N.
Exam Passed
1.
High School
2.
Intermediate
3.
B.A./B.Sc./B.Com./BBA
4.
M.A./M.Sc./M.Com.
5.
MCA/MBA
6.
Others
Year of
Passing
Board/
University
2
Subjects
Total
Marks
Obained
Division
%
Undertaking by the Student
I .............................................................................................................................. son/daughter of
Shri .............................................................................................................................Village & Post
Office ................................................................District ...................................State......................
hereby declare that the information furnished by me is corret to the best of my knowledge & belief.
Further, I undertake to follow the Hostel rules as well as the directives given by Hostel
Administration which are framed by the university from time to time and I shall be liable for disciplinary
action, including expulsion from Hostel, if I am found violating the same.
Date
Name
3
Signature
Forwarding remarks of Head of the Department / Research Supervisor
(PG, Pre-Ph.D. and Research students shall get their applications forwarded by the Head of the
Department concerned, and research Supervisor.
Recommendation of the Hostel Admission Committee
Shri/Km. .................................................................................................is recommended for admission
to...................................................................................... on the basis of his/her relative merit.
Date:
Signature of Chief Hostel warden
4
Verification Form (to be filled by the student)
1. Name
......................................................................................................
..........................................Subject
...........................................
Mobile No.
: ...............................................................................................
Class
email:
.........................................................................................................
2. Father's Name
................................................................................
3. Mother's Name
...............................................................................
The Photo
should be Attested
by the
warden/Chief
Warden
4. Date of Birth (Day,Month,Year).........................................................................
5. Category (SC/ST/OBC) .................................................................................
6. Permanent Address
..........................................................................
7. Address of Parent for Correspondence (if different from above)
(Phone /Fax/E-mail)/ Mobile ............................................................................
8. Name and Address of Local Guardian .............................................................
Phone/Fax/ E-mail /Mobile ...............................................................................
9. Name of the Hostel
10. Room No.
................................................................
..........................................................................
11. Hostel/Admission fee Receipt No....................Date.....................Sig. of Clerk
Signature of Chief Hostel Warden
Signature of Hostel Warden
Acknowledgement of Hostel Application Form, 2013-14
Received Application From Mr./Ms./Shri/Smt. ................................................................
Serial No. ................... for admission to the Hostel.
Date : .......... / ......... / 2014
Signature of Office In-charge