ewY; :0 50@&Mkd }kjk% :0 125@*
Form No.
Rs. 50/-, By Post Rs. 125/-
gs e orh uUnu cgq x q. kk x<+o ky fo'ofo|ky;] Jhuxj ¼x<+ o ky½
¼dsUæh; fo'ofo|ky;½
HEMWATI NANDAN BAHUGUNA GARHWAL UNIVERSITY, SRINAGAR (GARHWAL)
(A Central University)
izos'k gsrq vkosn u i= ¼2016&2017½
Application Form for Admission (2016 -2017)
1-
ifjlj dk uke
% ---------------------------------------------------------------------------------------------
Name of the Campus
2-
¼d½ izos'k gsrq d{kk dk uke % --------------------------------------------------------------------------------------------(a) Name of Class UG
PG
Diploma/Certificate
¼[k½ ikB~;Øe dh izd`fr
lkekU;
LofoÙk iksf"kr
(b) Nature of Course
General
Self finance
Ph.D..
fo"k; (LukrdksÙkj@,e-fQy-@ih,p-Mh-
vkosfnr fo"k; lewg Lukrd d{kkvksa ds fy, ¼ojh;rk Øe esa½%
Subject (PG/M.Phil/Ph.D.)
Subjects applying for UG Classes (in order of Preference)
1- --------------------------------------------------
3-
M.Phil.
To affix recent
Photograph for
all students is
neccessary
a) 1
----------------------------2 - -----------------------------3- ------------------------
b) 1
----------------------------2 - -----------------------------3- ------------------------
c) 1
----------------------------2 - -----------------------------3- ------------------------
izos'kkFkhZ dk iwjk uke ¼gkbZLdwy izek.k i= ds vuqlkj½% Full name of Applicant (as per High School Certificate)
fgUnh esa (in Hindi)
vaxzsth esa (in English)
45-
tUefrfFk
¼v½ vadksa esa %
Date of Birth
(a) in figures Date
Year
(b) in words :
vk;q ¼1 tqykbZ 2016 dks½ %
Age (as on 1 July, 2016) :
67-
¼c½ 'kCnksa esa % ------------------------------------------Month
fyax (Sex)
firk dk uke
---------------------------------------------------------------------------------------------------------------------------
% iq:"k (Male)
efgyk (Female)
% ---------------------------------------------------------- ekrk dk uke ---------------------------------------------
Father’s Name
89-
10-
11-
12-
(Mother’s Name)
/keZ (Religion)
% -----------------------------------------------------------------------------------------------------------------------ekrk@firk dk LFkk;h irk % --------------------------------------------------------------------------------------------------------------------------Permanent Address
% --------------------------------------------------------------------------------------------------------------------------LFkkuh; vfHkHkkod dk uke% -------------------------------------------------------------------------------------------------------------------------irk o Qksu ua0
----------------------------------------------------------------------------------------------------------------------------Name of Local Guardian ------------------------------------------------Nk= ls lEcU/k (Relation) -----------------------------------------Address & Phone No. ----------------------------------------------------------------------------------------------------------------------------(i) oxZ Category % ¼v½ lkEkkU; oxZ ¼GEN½
¼c½ fiNM+h tkfr (OBC)
¼l½ fodykax (PH)
¼n½ vuqlwfpr tkfr ¼SC½
¼;½ vuq0 tutkfr ¼ST½
¼;½ lSfud ¼Defense
(ii)
¼v½ ch-ih-,y- (BPL)
¼c½ ,-ih-,y- (APL)
jk"Vªh;rk % ¼v½ Hkkjrh; ¼jkT; dk uke½
Nationality
¼c½ fons'kh ¼ns'k dk uke½
Indian (Name of the State)
13-
osSokfgd fLFkfr
14-
ekrk@firk dh ekfld vk;
Marital Status
%
Foreigner (Name of the Country)
¼v½ vfookfgr
Unmarried
¼c½ fookfgr Married
% -----------------------------------------------------------------------------------
Monthly income of Father/Mother :
15-
vfUre laLFkk dk uke ftlesa f'k{kk izkIr dh
% ------------------------------------------------------------------------------------
Name of the Institution last attended :
16-
;fn izos'kkFkhZ ukSdjh djrk gS rks laLFkk dk uke o irk % -----------------------------------------------------------------------------------If the Applicant is employed Name &
Address of the Organisation
¼laLFkk/;{k ls vukifRr izek.ki= layXu djsa½
% -----------------------------------------------------------------------------------(Enclose 'No-objection Certificate' from Head of Institution)
*vkosnu i= ds fy, fMekaM Mªk¶V vf/k"Bkrk Nk= dY;k.k ds uke ns; gksxkA
For admisstion form the DD will be drawn in favour of the Dean Student Welfare)
uksV % foLr`r tkudkjh ds fy, d`i;k izos'kkFkhZ funsZf'kdk dk voyksdu djsaA
Note: For further details please see Prospectus).
17-
foxr ijh{kkvksa dk fooj.k % LFkkukUrj.k izek.k i= rFkk pfj= izek.k i= ewy:i esa ,oa fofHkUu ijh{kkvksa ds vadi=ksa o
izek.k i=ksa dh izekf.kr izfrfyfi;k¡ vfuok;Z :i ls layXu djsaA viw.kZ vkosnu i= ij fopkj ugha fd;k tk;sxkA
Details of the previous Examinations. (Original Transfer and Character certificate along with the attested copies of
mark sheets must be enclosed with the form. Incomplete forms shall not be entertained)
ijh{kk dk uke
Name of Exam
o"kZ
cksM@
Z laLFkku
fo"k;
Js.kh
Year
Board/University
Subjects
Div.
dqy vad
izkIrkad izfr'kr
Total marks M.Obtained
gkbZLdwy
High School
b.VjehfM;V
Intermediate
ch-,-@ch-dkWe-@ch-,llhB.A./B.Com./B.Sc.
,e0,-@,e-dkW e-@,e-,llhM.A./.M.Com./M.Sc.
ch0 ,M0
B.Ed.
vU;
Other
18-
vfUre mÙkh.kZ ijh{kk (Last Examination Passed
ijh{kk ¼Exam½ ------------------------------------------------ o"kZ ¼Year½ ---------------- vuqØekad ¼Roll No.½ -----------------------------fo"k; ¼Subject½ ---------------------------------------------------------------------------------------- ifj.kke ¼Result½ -----------------------------------laLFkk dk uke ¼Name of Insitutute) --------------------------------------------------------------------------------------------------------------
19-
ikB~;sRrj xfrfof/k;ksa esa lgHkkfxrk
¼1½ [ksydwn
Participation in Extra Curricular Activities
¼2½ ,u0 lh0 lh0
Sports
NCC
¼3½ ,u0,l0,l0
NSS
¼4½ vU;
Other
¼izekf.kr izfrfyfi;k¡ layXu djsaA½ (Attach Photocopies of the certificates)
esSa ;g ?kks"k.kk djrk@djrh g¡w fd mi;qDr lHkh fooj.k esjs Kku ,oa fo'okl ds vuqlkj lgh gaSA eSa ;g Hkh ?kks"k.kk
djrk@djrh gw¡w fd tc rd eS bl fo'ofo|ky; ifjlj dk fo|kFkhZ jg¡wxk@jg¡wxh rc rd leLr fu;eksa dk ikyu
d:¡xk@d:¡xhA eS ;g ?kks"k.kk Hkh djrk@djrh g¡w fd eSa fdlh vU; laLFkku dk fu;fer Nk=@Nk=k ugha g¡Aw ;fn fu;e ikyu
,oa lwpuk;as nsus esa dksbZ =qfV ik;h x;h rks mldk mRrjnkf;Ro esjk gksxkA
I hereby declare that all particulars given in this application are correct to the best of my knowledge and
belief.I also declare that I shall abide by all the rules and regulations of the University till such time as I remain student
in the University Campus. I also declare that I am not a regular student of any other institution. I shall be responsible for
the information furnished by me and following the rules of the University.
¼vfHkHkkod ds gLrk{kj½
¼izos'kkFkhZ ds gLrk{kj½
Signature of Guardian
Signature of applicant
layXudkas dk fooj.k 1½ ------------------------------------------------Details of enclosures: 2 ½ -------------------------------------------------
3 ½ ------------------------------------------------4 ½ -------------------------------------------------
izos'k lfefr dk fu.kZ;
Decision of Admission Committee
la;kst d] izo s' k lfefr
(Convenor,
Admission Committee)
¼eq[ ; fu;Urk }kjk izfrgLrk{kfjr½
Counter signed by Chief Proctor
¼u;s izos'kkfFkZ;ksa ij ykxw ugha½
(Not applicable for newly admitted student)
dk;kZy; mi;ksx gsrq
foHkkxk/;{k
funs'kd@Mhu vkW Q Ldwy
(Head of Dept.)
(Director/Dean of Schools)
eqgj
(Seal)
(For Office Use)
'kqYd jlhn la[;k Fee Receipt No ------------------------------------------------- ifjlj 'kqYd [kkrk la[;k Campus Fee A/C No. ------------------------- fnukad Date ---------------- d{kk Class ------------------------------------------------- dqy izkIr 'kqYd dh èkujkf'k Total Amount of
Fees --------------------------------------------------------------A
¼'kqYd fyfid ds gLrk{kj½
(Signature of Clerk)
STUDENT SUMMARY FORM (2016-17)
1. Name of the Student
(In English Block Letters) ...........................................................................................................................
(In Hindi) .................................................................................................................................................
2. Father’s Name ........................................................................................................................................
3. Mother’s Name .......................................................................................................................................
4. Date of Birth ...........................................................................................................................................
5. Religion ...................................................................................................................................................
6. Caste ......................................................................................................................................................
7. Sex : Male/Female .................................................................................................................................
8. Admission Details
a. Name of School .........................................................................................................................
b. Class ..........................................................................................................................................
c. Subject .......................................................................................................................................
9. Category :
a. SC/CT/OBC/GEN .....................................................................................................................
b. FF/PH/VH/X-Army ....................................................................................................................
c. APL/BPL ....................................................................................................................................
10. Name of State of Domicile ....................................................................................................................
a. Tehsil .........................................................................................................................................
b. Block .........................................................................................................................................
c. Police Station ............................................................................................................................
11. Permanent Address with Pin Code No. and Phone No.
...........................................................................................................................................................
...........................................................................................................................................................
...............................................................................................................................................................
12. Present address for correspondence with Pin Code No. and Phone No.
...........................................................................................................................................................
...........................................................................................................................................................
................................................................................................................................................................
13. Name and address of the College/ Campus/ Institute last attended with year of passing out
...........................................................................................................................................................
................................................................................................................................................................
14. Bank Account No. with Name and Branch of the Bank
...........................................................................................................................................................
...............................................................................................................................................................
15. Name, Address & Phone No. of person to be contacted in case of emergency/ Local Guardian
................................................................................................................................................................
................................................................................................................................................................
................................................................................................................................................................
For Office Use
Admission Fee Receipt No. ......................................................... Date .......................................................
Date ....................
Signature of Student
Convenor of Admission Committee
gseorh uUnu cgqxq.kk x<oky fo'ofo|ky;] Jhuxj ¼x<+oky½
¼dsUæh; fo'ofo|ky;½
HEMWATI NANDAN BAHUGUNA GARHWAL UNIVERSITY, SRINAGAR (GARHWAL)
(A Central University)
fu;Urk dk;kZy; ds fy, izi=
Form for Proctor Office
Session
1- Nk=@Nk=k dk uke
% -------------------------------------------------------------------------------
Student's Name
To affix recent
Photograph for
all students is
neccessary
2- ¼i½ ekrk dk uke (Mother's Name)% ---------------------------------------------------------------------------¼ii½ firk dk uke (Father's Name) -----------------------------------------------------------------------------3- d{kk ftlesa izos' k pkgrk@pkgrh gS
Class in which admission is sought ----------------------------------------------------------------------------------------------------------4- Nk=@Nk=k dk LFkk;h irk] nwj Hkk"k ua % ------------------------------------------------------------------------------------------------Permanent address of the student ------------------------------------------------------------------------------------------------------------5- LFkkuh; vfHkHkkod dk uke o irk%-----------------------------------------------------------------------------Qks- ---------------------Address of Local Guardian
Ph.
6- fiNyh laLFkk dk uke vkSj irk %-------------------------------------------------------------------------------------------------------ftlesa vH;FkhZ us v/;;u fd;k %-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----Nk=@Nk=k dh fiNyh 'ksSf{kd ;ksX;rk dk fooj.k Details of Previous Educational Qualification of Student
Name of the Institu ion last att ended
7-
ijh{kk mRrh.kZ
o"kZ
Exam Passed
cksMZ@ fo'ofo|ky;
year
Board/University
gkbZL dwy High-School
b.VjehfM,V Intermediate
ch-,-@ch-,llh-@ch-dkW e B.A/ B.Sc./ B.Com.
,e-,-@,e-,llh-@,e-dkW e M.A./ M.Sc./ M.Com.
ch-,M- B.Ed.
vU;
8-
Other
Nk= dks vkoafVr fo"k; ¼vuqo xZ½ ¼ UG½1 -------------------------2 -----------------------------3 -------------------------------------Subject allotted
(PG)
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
(M.Phil/Pre-Ph.d)
fu;Urk dk;kZy; }kjk Hkjk tk;
To be filled by Proctor-Office
------------------------------------- d{kk Class --------------- fo"k; Subject ------------------------------------------------------'kqYd jlhn la[;k Fee Receipt No. ----------------------------------- fnukad Date-------------------------A
uke
Name
¼'kqYd
fyfid ds gLrk{kj½
(Signature of Clerk)
cM+s v{kjksa esa Hkjsa
l= ¼ Session)%
(Fill in Block Letters)
---------------------------------
1. Students Name (Nk= dk uke) ..................................................................................................................................
2. Father's Name (firk
dk uke ) ..................................................................................................................................
dk uke) ................................................................................................................................. To affix recent
Photograph for
4. Date of Birth (tUe frfFk) ...........................................................................................................................................
all students is
5. Blood Group ([kwu dk xzi
q ) ......................................................................................................................................... neccessary
6. Class (d{kk) ................................................................................................................................................................
3. Mother's Name (ekrk
7. Permanent address of the Student : ...........................................................................................................................................................
....................................................................................................................................................................................................................................
Signature of Student
Instructions:
1. Every student must have a valid Identity Card duly signed by Proctor.
2. The student will have to produce Identity Card during inspection in the University Campus.
3. Identity Card is valid only for the current session 2016-17.
4. Identity Card is non-transferable and any change after issuance will be liable to punishment.
5. In the event of its loss a duplicate Identity Card will be issued on the payment of Rs. 100/-.
gseorh uUnu cgqxq.kk x<oky fo'ofo|ky;] Jhuxj ¼x<+oky½
¼dsUæh; fo'ofo|ky;½
HEMWATI NANDAN BAHUGUNA GARHWAL UNIVERSITY, SRINAGAR (GARHWAL)
(A Central University)
iqLrdky; vkosnu i=
Application for Library
Session
1-
vkosnd dk uke
% --------------------------------------------------------------------------------------------------------
(Name of the Applicant)
To affix recent
Photograph for
all students is
neccessary
(i)
fgUnh esa (In Hindi)
% --------------------------------------------------------------------------------------------------------
(ii)
vaxzsth esa (In English)
% -------------------------------------------------------------------------------------------------------------------------------------------
2-
firk dk uke (Father's Name)
% -------------------------------------------------------------------------------------------------------------------------------------------
3-
ekrk dk uke
% -------------------------------------------------------------------------------------------------------------------------------------------
4-
nwjHkk"k ua0
5-
d{kk (Class)
% --------------------------------------------------------------------------------------------------------------------------------------------
6-
Øe la[;k
% ------------------------------------------------------- izos'k la[;k
8-
Nk= dks vkoafVr fo"k; ¼vuqo xZ½ ¼ UG) 1---------------------------2 -----------------------------3 -----------------------------------
(Mother's Name)
% -------------------------------------------------------------------------------------------------------------------------------------------
(Telephone No.)
(Sl. No.)
Subject allotted
PG
Admission No. -----------------------------
------------------------------------------------------------------------------------------------------
?kks"k.kk
(Declaration)
eSaus laLFkkxr Nk= ds :i esa l= 2016&2017 eas fo-fo- ifjlj esa izos'k izkIr dj fy;k gSA eSa iqLrdky; ds fu;eksa
dk iw.kZ :i ls ikyu d:¡xk@d:¡xh rFkk fo-fo- iqLrdky; dh lEifr dks fdlh Hkh izdkj dh {kfr ugha
igq¡pkÅ¡xk@igq¡pkÅ¡xhA
I have been admitted as regular student in the University campus in session 2015-2016. I shall follow the
rules of library and shall not make any damage to the property of the University Library.
firk@ekrk ds gLrk{kj
LFkkuh; laj{kd ds gLrk{kj
Nk=@Nk=k ds gLrk{kj
Father/Mother's Sig.
Sig. of Local Guardian
Sig. of Student
dk;kZy; mi;ksx gsrq
(For Office Use Only)
uke
Name----------------------------------------------------
Fee Receipt No.-------------------------------------
d{kk
fnukad
Class --------------------------
fo"k;
Date-------------------------------
Subject
------------------------------------'kqYd jlhn la[;k
dks izos'k fn;k x;k has been admitted.
¼'kqYd fyfid ds gLrk{kj½
¼iq L rdky;k/;{k½
(Sig. of Clerk)
(Librarian)
uksV% Note:
1- iqLrdky; vkosnu i= 'kqYd jlhn ds lkFk izLrqr djuk gksxkA
Library Form have to present alongwith fee receipt.
2-
iqLrdky; mi;ksx ds fy, Nk= dks viuk ifjp; i= lkFk ykuk vfuok;Z gSA fcuk oS/k ifjp; i= ds iqLrdky; esa
izos'k oftZr gSA
It is mandatory to bring the ID Card for using the library facilities. No student will be allowed in the library
without valid Identity Card.
gseorh uUnu cgqxq.kk x<oky fo'ofo|ky;] Jhuxj ¼x<+oky½
iqLrdky; mi;ksxkFkZ fu;ekoyh
1-
izR;sd Nk=@Nk=k dks iqLrdky; ls iqLrdsa le;&lkj.kh ds vuqlkj 28 fnu ds fy, vkoafVr gksaxh]
vxj dksbZ Nk=@Nk=k fu/kkZfjr vof/k rd iqLrdky; esa iqLrdsa okil ugha djrk@djrh gS rks mls izfr
fnu ,d :i;k foyEc 'kqYd ds :i esa vFkZ n.M nsuk gksxkA
2-
iqLrdsa fuEuakfdr la[;k ds vuqlkj vkoafVr dh tk;saxh%
v½
dyk@ foKku Lukrd ds Nk=@ Nk=k dks nks iqLrdsa rFkk okf.kT; Lukrd dks rhu iqLrdsaA
c½
dyk@ foKku@ okf.kT; LukrdksRrj ds Nk=@ Nk=k dks pkj iqLrdasA
l½
f'k{kk ladk; esa ch0,M0 gsrq rhu ,oa ,e0,M0 gsrq pkj iqLrdsaA
n½
O;olkf;d ikB~;Øe ds Nk=&Nk=kvksa dks rhu iqLrdsaA
;½
'kks/k Nk=@ Nk=k dks N% iqLrdsaA
2-
Nk=@Nk=kvksa dks ikB~; lkexzh dk vkoaVu funsZf'kr le; lkj.kh ds vuqlkj gh fd;k tk;sxkA
3-
Nk=@ Nk=k }kjk iqLrdky; ls iqLrd izkIr djus ds fy, iqLrd dk uke] ys[kd] d{kk vkfn dk fooj.k
iqLrdky; esa nsus ds nwljs fnu iqLrd miyC/k djkbZ tk;sxhA fdUrq mDr ekax i= dks rhljs fnu rd
lqjf{kr ugha j[kk tk;sxkA
4-
lanHkZ lkexzh rFkk v/;;u d{k lkexzh dk mi;ksx iqLrdky; ds vUnj gh fd;k tk;sxk] iqLrdky;
ls ckgj ds fy, bls vkoafVr ugha fd;k tk;sxkA
5-
vkoafVr iqLrdky; lkexzh dks vU; ikBdkas dh vko';drk ds vuqlkj dHkh Hkh okil iqLrdky; esa tek
djus dks dgk tk ldrk gSA fo'ofo|ky; ijh{kkvksa ls iwoZ iqLrdky; dh leLr lkexzh okil djuk
vfuok;Z gksxkA
6-
vkoafVr ikB~; lkexzh dh lqj{kk dk iw.kZ nkf;Ro izkIrdÙkkZ Nk= dk gksxk] vr% vkoafVr gks jgh lkexzh
dh iw.kZ tkap dj Nk= lUrq"V gks ysaA ikB~; lkexzh [kks tkus ij ;k QV tkus ij uohu laLdj.k ;k
iqLrd dk orZeku ewY; dh /kujkf'k iqLrdky; esa tek djuk gksxkA
7-
iqLrdky; fu;eksa@O;oLFkk ds fo:¼ vkpj.k djus ij iqLrdky; lfefr dks vf/kdkj gksxk fd og
ikBd dks iqLrdky; mi;ksx ls oafpr dj ns] ;k fo'ofo|ky; iz'kklu dks vuq'kklukRed dk;Zokgh
gsrq fy[kk tk;sxkA
8-
vns; izek.k i= ds bPNqd Nk=@ Nk=kvksa dks vkosnu i= iqLrdky; esa tek djus ds nwljs fnu vns;
izek.k i= fuxZr fd;k tk;sxkA
9-
ftu Nk=@ Nk=kvksa dks foHkkxh; iqLrdky; ls iqLrdsa vkoafVr dh tkrh gS mUgsa fu;e&1 ds vuqlkj
iqLrds vkoafVr djuk lEHko ugha gksxkA
10-
iqLrdky; ls vkoafVr iqLrd ,oa O;fDrxr ikB~; lkexzh v/;;u gsrq iqLrdky; esa ykuk oftZr gSA
iqLrdky;k/;{k
egksn;]
eSus iqLrdky; lEcU/kh fu;ekoyh dks iw.kZr;k i<+ vkSj le> fy;k gS] blds vfrfjDr iqLrdky;
O;oLFkkFkZ le;&le; ij fuxZr vU; lwpukvksa @ funsZ'kksa dk iw.kZ lR;fu"Bk ls ikyu d:¡xk @ d:¡xhA
vr% iqLrdky; mi;ksxkFkZ eq>s vuqefr iznku djus dh d`ik djsaA
vfHkHkkod ds gLrk{kj -----------------------------------------
Nk=@Nk=k ds gLRkk{kj ----------------------------------------------
LFkk;h irk
-----------------------------------------
iwjk uke
----------------------------------------------
-----------------------------------------
irk ,oa Qksu ua-
----------------------------------------------
-----------------------------------------
---------------------------------------------
University Career Counseling and Placement Service
IIND Floor, Central Library, HNBGU, Srinagar Garhwal – 246174
Phone: - 01346-250722, Fax: - 01346-250723
E-mail:- [email protected]
Session – 2011-2012
2016-17
Note:- Please fill all details in block letters:
 Please affix your recent coloured photograph in the space provided
 Completed forms may be deposited with the office of the Service on
the top floor of Central Library Building (in case of the Birla and
Chauras Campuses) and with the Placement Cell / Campus
Director's Office (in case of BGR Campus, Pauri and SRT Campus,
Badshahithaul)
Recent
Photograph
PERSONAL INFORMATION :
Class ____________________________________
Date of Birth ____________________________
Full Name_________________________________
Gender ________________________________
Father’s Name _____________________________
Mother’s Name __________________________
CONTACT INFORMATION :
Permanent Address (with PIN Code): _____________________________________________________
___________________________________________________________________________________
Present Postal Address (with PIN Code): __________________________________________________
___________________________________________________________________________________
Residence/Permanent Contact Phone Number (with STD Code) ________________________________
E-Mail ID: _____________________________ Mobile/Phone No.: ______________________________
ACADEMIC INFORMATION :
(Details of all Examinations passed including additional / Vocational qualifications acquired from other institutions)
S.
No.
Class
Year of
Passing
University / Board
Subjects
Division
%age of
Marks
1
2
3
4
Other
CAREER PREFERENCES :
(Please state below the Counselling/ area of employment you would prefer to take up as a career. You may seek
the help of the personnel of the Service in making the choice.)
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Name of the Student
Date
Signature