SARDAR BHAGWAN SINGH
UNIVERSITY
Balawala, Dehradun
APPLICATION FORM
Name of the Applicant __________________________________________
Father's Name _________________________________________ Affix self
Mother's Name __________________________________________ attested
passport size
Date of Birth __________________________________________
photograph
Courses applying for UG PG Choice 1.____________________
Choice 2. ______________________Choice 3.________________________
Category: (a) Uttarakhand Other State
(b) SC ST Sikh Minority General Ex-Student OBC
Educational Qualification:
[Link]. Name of Exam Board/University Total Marks Aggregate
%
1. 10**
2. 10+2 or equivalent
3.
10+2+3 or equivalent
4. [Link]
*Indicate PCM/PCB Marks only.
** for Diploma in Engineering Only
# Weightage if any A B C D E # Refer Para 6.0
Correspondence Address ___________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Phone Number _______________________ Email Id _______________________________________
Permanent Address ________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________
Phone Number __________________________
Application process / Entrance Fee Details: (a) Cash Receipt No.
(b) Draft No.
Bank__________________ Date____________________
I solemnly affirm that the particulars given above are true.
Enclosures: Please refer check list
(1) (2) (3)___________________
(4) (5) (6)____________________
Date ___________________
Place ___________________
Signature of the Applicant
FOR OFFICE USE ONLY:
Ref No.: Received On. : Roll No.
Admit Card prepared on___________________________
Form found Complete Incomplete
Discrepancies found
1.
2.
3.
4.
Candidate Informed Not Informed Date__________________
Checked by Re-Checked by____________________
SARDAR BHAGWAN SINGH
UNIVERSITY
Balawala, Dehradun
ADMISSION FORM
1. (a) Name of Candidate (IN BLOCK LETTERS) : Affix self
_______________________________________________________________________
attested
passport size
(b) Name of Course ______________________________________________________
photograph
2. (a) Father's Name Occupation __________________
(b) Mother's Name Occupation __________________
3. Date of Birth Nationality _________________________
4. Present (Correspondence) Address: _____________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
City / District: Pin Code __________________ State ________________
Phone No. (Resi)Code No. ___________ (Office)Code __________ No. ___________
Mobile (Father's) ______________________ Email: _______________________________________
Mobile (Mother's) Any Other___________________________________
5. Permanent Address: _______________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
City / District: _____________ Pin Code State ___________________
Phone No. (Resi)Code No. ___________ (Office)Code __________ No. ___________
6. Apply for Scholarship: Yes No
7. Annual Income: (1) Father (2) Mother (3) Guardian ____________
(b) SC ST SikhMinority General Ex-student OBC
8. Educational Qualification:
[Link]. Name of Exam Board/University Total Marks Aggregate
%
1. 10**
2. 10+2 or equivalent
3.
10+2+3 or equivalent
4. [Link]
*Indicate PCM/PCB Marks only.
** for Diploma in Engineering Only
9. Local Guardian's (if any) Particulars: (for Hostelers)
(a) Name ______________________________ Relation _______________________________
(b) Address: _______________________________________________________________________________
Phone No. (Resi) Code ________ No. ____________ (O)Code ______ No. _____________________
Mobile ____________________________ Email: ________________________________
10. Any extra curricular activity (State/National Level): Sports ___________ Others ________________
Please provide the details. (Attach as appendix, if required)
11. Are you employed? Yes [ ] No [ ]
(If yes, attach “No Objection Certificate”)
12. Enclosures (As per check list):
(1) (2) (3) ____________________
(4) (5) (6) _____________________
(7) ____________________
JOINT DECLARATION BY THE APPLICANT AND THE PARENT/ GUARDIAN
1. I declare that I have carefully read the instructions given in information brochure and the entries made by me in
this form are correct to the best of my knowledge, and nothing has been concealed.
2. I undertake to observe proper standards of academic conduct.
3. I shall abide by the prescribed course of reading and the modes of examination which may prevail from time to
time, even though these may be at variance with those of the previous years. It will be may whole responsibility to
go through the course ordinances, which may be changed by the university from time to time.
4. I undertake to fulfill mandatory 75% attendance in the course of study, failing which I will not be allowed to
appear Sessional / University examinations, since I would become ineligible for the same.
5. I shall abide by the rules and regulation as given in the Hand Book of Information or that may be framed by the
University from time to time.
6. I shall faithfully carry out the instructions issued by the Vice-chancellor of the University and other authorities.
7. I hold myself responsible for due and prompt payment of fees and all other dues as per prescribed dates.
8. I understand that my admission is liable to be cancelled if any of the statement furnished above, by me is found
to be incorrect.
9. I understand that I cannot concurrently be enrolled for more than one full time course of studies.
Place:
Date: Signature of the Applicant
I certify that my Son/ Daughter/ ward is making this application with my permission. I hold myself responsible
for his / her good conduct and behavior as a student of the University and payment of all his / her fees and dues
during his / her stay in the University.
Place : Date: _______________
Signature of the Parent / Guardian
Address :
Name _____________________________
Tel No. ____________________________
Form / documents checked by ______________________ Counter Checked By _________________________