INTERNATIONAL APPLICANTS
.--------------------·---
Serial No ...... .
0.0./Cash Coupon No ........... .
DATE: ................................... .
VISVA-BHARATI
SANTINIKETAN-731235
WEST BENGAL, INDIA
Attach one recently
taken passport size
photograph duly
attested.
Application for Admission to ------------------------ Session 20 - 20
(Write the name of the Institute)
[ Please tick ( V) in the appropriate place and strike out which is not applicable]
I. Admission sought for
a) Programme of study
b) Major Subject
c) Subsidiary"or other Subject(s), if any
2. Name in Full (In BLOCK LETTERS)
3. Sex : Male D Female D
4. a) Whether a person of Indian Origin
b) Whether Non-Resident lndian
c) Mother Tongue
5. a) Date of Birth : Day
b) Place of Birth :
6. Hostel Accommodation :
7. Address
For correspondence
'
Name
Location
City
Post Office
Postal Code
State
Country
Telephone No. (i)
Cellphone No. (ii)
Fax No.
e-mail
4. Nationality :
Yes D
Yes D
NoD
NoD
Month Year _________ __
Necessary D Not necessary D
Permanent Father/Mother/ A person's address
Address Spouse/ who can be
Guardi:m's contacted in case
address of emergency
'
g. Language Known Can Speak Can Read Can Write
P. T. 0.
9. Details of Educational Particulars
LeYeUCourse of Name of the :\"arne of Programme/ Year of *Result Subjects/
study completed examination Board/ Course Admission Passing Division/ Average papers
Diploma/ UniHrsity/ Duration Class/ marks in oiTercd
degree Institute Grade terms of
etc. percentage
(
Scc"Ondary or
. •
' eqUivalent I
Senior School
Ccrttficatc/Higher
Secondary (I 0+2)
or equivalent
N
Bachelor's Degree
(B.A./B.Sc./
B.Mus./B.Finc
Arts etc.)
in
Master's Degree
(M.A.fM.Sc./
M.Mus.IM.Fine
Arts etc.) .

In ....

10. a) Present Occupation
b) Designation, if employed
c) Annual Income (in U.S. Dollar)
d) Name, contact address, telephone, fax & e-mail of employer : -------------
11. In case, Financially supported from any organization/Individual :
a) Name of the Organization/Institute : ___________ _
b) Address : ----------------------------------
12. Passport No. : -------------- Date of Issue : ------------
Place of issue :-. -------------- Valid till : -------------
I 3. Visa : Type --------------- No. -----------------------
Place of issue : ------------------------- Date of Issue : -----------------------
14. Detai Is of the Course (s) or studies taken by the candidate earlier or currently taken in Visva-Bharati :
Year Course of Department Institute/ Registration Year Result
of Study Bhavana No. (Division/
Study Class)
15. Whether the applicant is prepared to take an entrance test at Visva-Bharati : Yes D No D
16. Purpu~e of Study :
17. Special interest. if any :
18. Institutions where you have studied since Secondary level education :
LcveVCourse of Study Year Name of the Address Telephone Nu./
of SchoolJCollege Fax No./e-mail
passing Institute etc.
(a) (b) (c) (d) (e)
[ 4 1
19. Referee - particulars :
Name Designation
Referee I
Referee 2
Referee 3
20. Only for Fine Arts/Performing Arts disciplines :
Details of the attached Photograph/CO/Cassettes, etc. of works.
21. Only for Research Programme (Ph.D./D.Litt.ID.Sc. etc.) :
(A) Broad field of proposed Research Work
(A synopsis of the proposed work is
to be attached) -
(B) Tentative Title of the proposed thesis
(to be given in the language in which
the thesis will be prepared as well as
its English translation)
(C) Named of Supervisor(s)
(If the candidate has any choice)
(D) (i) Research/Field experience, if any
(E) Permission from Government
Permission Letter No.
Issued by
Declaration :
(I)
(2)
Contact Address Telephone No.
Dated
I. The statements made above are true to my knowledge and belief. In case any entry or information or
document(s) is/are found to be false/fake, this shall entail automatic cancellation of my admission besides rendering me liable to such action as the university may deem proper.
2. If selected,
(a) I shall abide by the rules and regulations of Visva-Bharati and take part in the traditional functions
and festivals of Visva-Bharati
(b) I shall not engage in (i) political activities, (ii) activities prejudicial to the interest of the University
as well as to India (iii) activities which could be embarrassing to the relations between India and
any foreign country.
(c) I shall abide by the rules of discipline and proper conduct which may be applicable.
(d) I shall not leave the Headquarters without prior permission of the concerned University authority.
Signature of the Applicant
[ 5 ]
CHECK LIST for the Applicant :
Please put ' V ' (tick) marks.
(I) Whether entered All relevant particul ars in the Applicant From YES D NO D
(:!) ATTACHMENTS
(i) Passport-size photograph duly attested YES D NO D
@ Educational Documents attached (put ' V ' (tick) marks) :
Level of Photocopies of Academic Equivalence Remarks
Exammation Markshccts & Transcnpts Certi fie ate
Certificates
Whether Whether Whether
Atlested Attested Attested
Secondary (10 Yrs.)
or Level or - -
equivalent
Higher Secondary/
Senior School '
Leaving Certificate or
equivalent ( I 0+2 Yr.)
Bachelor's Degree/
GraduatiOn or
eq uivalent
(B.A .. B.Sc .. B.F.A., -
B.Mus. etc.)
Master's Degree
or equivalent
(M.A., M.F.A.,
M.Mus. etc.)
Any other degree/
diploma
(3) Medical/Health Certificate attached : YES D NO D
(4) Blflh Certi ficate attached : YESD NO D
(5) Two Referee's Certificates attached : YES D NO D
(6) No Objection Certificate/School or College Leaving Certificate YESD NO D
(if already studying in an Indi an Institute) attached :
(7) Additi onal attachments :
(A) For Fine Arts Courses only
At least 6 colour photographs attached YESD NO D
Whether attested YES D NO D
(B) For Performing Arts Courses only
Audio-visual/ Audio COs/Cassettes attached YES D NO D
Whether attested YES D NO D
(C) For Research!Ph.D./D.Sc./D.Litt. only
A short synopsis of the topic indicating
(i) the field of Research YESD NO D
(ii) Tentative title of the thesis YESD NO D
AND
"No Objection Certificate" from the employer, if the YESD NO D
applicant is in employment :
Price Rs. 400.00 I 10 U.S. Dollar only.