APPENDIX-I
ADMISSION FORM FOR ACADEMIC PROGRAMMES
2013-14
1. Full Name of the candidate (as it appears in the Leaving Certificate in capital leters):
2. Date of Birth (dd/mm/yy): ...................................//.....................................//..................................
3. Father’s Name..............................................................................................................................................................
4. Mother’s Name...........................................................................................................................................................
5. Contact Address:
...............................................................................................................................................................................................
....................................................Pin Code...........................................Email......................................................................
6. Permanent Address:
...............................................................................................................................................................................................
...............................................................................................................................................................................................
........................................................................................................................Pin Code........................................................
8. Nationality: .................................................................................................................................................................
9. Category (Please Tick):
General / Scheduled Tribe / Scheduled Caste / OBC (Creamy layer) / (Non creamy)
(OBC as per the Central List of National Commission for Backward Classes, GOI)
10. Differently – Abled (with a minimum 40% disability) (Please tick): Yes No
a. Nature of Disability: Physical/Visual/Hearing/Any Other (Please tick)
11. Programme of Study (Please select (√) only one):
Please paste a
passport size,
self-attested
colour
photograph
Ph.D* M. Phil* M.Sc. M.A.
M.Com BCA-MCA integrated BA-MA integrated B.Sc-M.Sc integrated
M.Ed BA-LLB-LLM integrated BPA-MPA integrated
PG Diploma in Tea Management
*For PhD and MPhil admission an applicant must submit in about 200 words a statement on two areas of research interest,
in order of priority, and why he/she wishes to pursue them.
SIKKIM UNIVERSITY
[Last Date for Submission-15th July 2013]
12. Department (Please select (√) maximum 3 and mark them as 1, 2, and 3 in order of priority)
13. Academic Record
14. Present Employment Record (If Employed)
Anthropology Ethno-Botany and Social
Medicine Studies
Chemical Sciences Asian Language (Chinese)
Commerce Computer Sciences and
Applications
Economic Studies and
Planning
Education English Geography and Natural
Resource Management
Earth Sciences
Hindi History Floriculture and Horticulture
Management
Law and Legal Jurisprudence
Studies
International Relations/
Politics
Management Journalism and Mass
Comm.
Mathematical Sciences
Microbiology Music Nepali Language and
Literature
Peace and Conflict Studies
and Management
Physical Sciences Political Science Psychology Studies Social Systems and Anthropology
Tourism Zoology
Name of the
Examination
Year of Passing Percentage/
CGPA
Name of the
Institution
Board/University
Subject Combination
Matriculation or
Equivalent
Hr. Sec. or
Equivalent
Graduation or
Equivalent
Master’s degree
MPhil
Any Other
Name of the Organization
and Address
Position Held Period Nature of Duties
Certified that the information provided above are true to the best of my knowledge and belief. If found untrue,
the University may take such action as it may deem fit.
Place and Date: Name and Signature of the Candidate
(If employed, a separate certificate of employment from the employer is to be submitted by the candidate)
APPENDIX - II
ADMISSION FORM FOR HOSTEL ACCOMODATION
APPLICATION FORM FOR BOYS’ HOSTEL :
APPLICATION FORM GIRLS’ HOSTEL :
Please paste a
passport size,
self-attested
colour
photograph
1. Name .......................................................................................................................................................................
2. Programme of Study ...............................................................................................................................................
3. Department ............................................................................................................................................................
4. University ID No .....................................................................................................................................................
5. Date of Birth and Place .........................................................................................................................................
Male/Female……………...........................................................
6. Category : DA/SC/ST/OBC/GEN
7. Contact Nos.: ........................................................................................................................................................
8. E-mail id ................................................................................................................................................................
9. Blood Group ...........................................................................................................................................................
10. Correspondence Address (with contact details)
...................................................................................................................................................................................
...................................................................................................................................................................................
...................................................................................................................................................................................
11. Permanent Address
...................................................................................................................................................................................
...................................................................................................................................................................................
...................................................................................................................................................................................
12. Any illness which requires continuous or emergency medical attention
If yes, nature of illness ...................................…………………………………………………………………
SIKKIM UNIVERSITY
13. Local Guardian
(a) ..................................................................................Local Guardian’s Name ………………………………
(b) ...............................................................................................Occupation : …………………………………
(c) ..........................................................................................................E-mail id ……………………………….
(d)................................................................................. Address : ………………………………………………
...................................................................................................................................................................................
...................................................................................................................................................................................
Mobile no. ……………………..
I hereby state that the above information is true to the best of my knowledge and belief and that:
1. I have read all the “Rules and Regulations for Hostel Residents” (Enclosed along with hostel allotment
form) and promise to abide by them enforced and to be enforced from time to time by
University Authority/management.
2. I shall not indulge myself in ragging in any form and I shall accept the punishment awarded by the
concerned authority in this regard if found guilty of this.
3. I shall not indulge in any act of indiscipline, misbehaviour and maintain complete harmony with
all other inmates.
4. I shall compulsorily join the hostel mess and pledge myself to abide by the rules and regulations of
the hostel mess, enforced and to be enforced from time to time by University Authority/management.
5. I will pay all dues, i.e., Hostel fee, Mess fee, Tuition fee etc in time.
6. I further undertake that in case of any complaint of misbehaviour, disobedience, violation of the
rules and/or any act of indiscipline, any necessary action taken by the authorities will be acceptable
to me.
(Signature of the Student)
Name :
Date :
Documents to be produced at the time of Hostel Room Allotment (before 1st August, 2013)
Residential address proof (Ration Card/Water Bill/Electricity Bill/Bank Passbook etc.) for parent’s
address.
Copy of parents’ / guardians’ Identity Card having Photo and Signature.