CENTRAL UNIVERSITY OF JHARKHAND
(A Central University established by an Act of Parliament of India in 2009)
Brambe, Ranchi-835205
Jharkhand
Admission Application Form
PERSONAL DETAILS
Name
Father’s Name
Mother’s Name
Sex
Please circle one - Male / Female
Date of Birth (DD/MM/YYYY)
Category
Please circle one - Gen / OBC / BC / SC / ST
Nationality
Religion
Physically Challenged
Please circle one – OH / VI / HI
Emergency Contact Name
Emergency Contact Number
COMMUNICATION DETAILS
Mailing Address
Permanent Address
Phone
Fax
Mobile
Email
Registration Number (for office use only):
Preferred Exam Venue:
Course(s) Applied for : Option1
Option2
photo

ACADEMIC DETAILS Name of Board Subject Examination Year Marks %
SUBJECT DETAILS Subject Marks %
Have you represented India or State in any Sports ?
Yes /No?
If Yes, name of sport(s): SCHOLARSHIP DETAILS Name of the Award Year Reason for Award
3
UNDERTAKING
I, Sri/Ku…………………………………………………………………………………..,
S/o/ D/o………………………………………………………………………………….., do hereby declare that the particulars furnished above are true and correct to the best of my knowledge and belief.
I do further undertake that in case of any information being found incorrect at any stage, my candidature for the admission/ selection to the course may be cancelled and appropriate disciplinary action may be taken against me. I also agree to abide by the rules and regulations of the University. In case of breach of discipline, disobedience of rules and/ or unsatisfactory conduct, I shall be liable for expulsion from the institution and for criminal action as per law. I am willing to shift to any other campus within the State of Jharkhand when the University shifts to its permanent location.
Signature of the Father/ Guardian Signature of the Applicant
Date:
Place:
FOR OFFICE USE ONLY
Please circle whether : Admitted / Not Admitted
In case admitted, name of the course
Signature of Competent Authority
Name :
Registration No :
(for office use only)
Signature :
DRAFT DETAILS No Date Amount Issued By Payable At