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
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