RAJIV GANDHI UNIVERSITY
RONO HILLS, DOIMUKH-791 112
ARUNACHAL PRADESH
APPLICATION FOR ADMISSION

SL No:…………

PASTE A RECENT
PASSPORT SIZE
PHOTOGRAPH
DEPARTMENT/INSTITUTE
SESSION
COURSE OF STUDY
Personal Details
1. Name: Mr/ Miss/Mrs
2. Father’s / Husband’s Name
3. Mother’s Name
4. Date of Birth
Day Month Year
5. Category (specify) SC ST OBC Gen
6. Address
a) Permanent :-......................................................................................................................................
.............................................................................................................................................
b) Local Guardian’s address:-...........................................................................................................................
......................................................................................................................
7. Contact Details: Landline (Home) Cell phone
8. Whether Physically Challenged ? Yes No
9. Whether ward of ex-Service man ? Yes No
10. Whether Kashmiri Migrant ? Yes No
11. Whether having Certificate of NCC/NSS/Sports (State, National & International)?

ACKNOWLEDGMENT
Received Application No. :-……………………………. Dated :-…………………..
by the P.A to HoD/Director.......................…………………….....Dept./Institute, Rajiv Gandhi University
Sign. of the PA
12. Educational Qualification
Name of Exam Board/ Year of Subject (s) Mark %age of Remarks
University Passing Offered obtained Marks
High School (Class X)
Higher Secondary (10+2)
Graduation Course (Hons)
Graduation Course (Pass)
B.Ed
Post Graduate Course
M.Phil
Technical Course
Professional Course
13. University Registration Number with year (if already Registered):………..............................……………………
14. Whether in Service? Yes No (If yes, attach No Objection Certificate from your employer)

DECLARATION
i. I do hereby declare that the above stated information are true to the best of my knowledge. If any information proves to be wrong, I shall be liable to action as per rules of the university. I have gone through the rules of admission etc. and shall abide by the same in the event of my admission.
ii. In case of my selection and admission in the university I shall attend a minimum of 75% of the classes, seminars, tutorials, etc. as per the university rules, failing which I may be disqualified from appearing the university examination.

VERIFICATION & SELECTION
Verified and found correct
Name and Signature of Members, Admission committee
1. ………………………………………………2. ……………………………………... 3. ...............................................
Admission : Allowed Not allowed
Roll No Allotted :- ………………………………………... Name and Signature of Head/Director of the Dept./Institute
CHECK LIST
The following self attested photostated documents must be attached with the Application form.
i. Certificate of age proof.
ii. Certificate and mark sheet of all examinations passed (Class X onwards, 2 copies each)
iii. ST/SC/OBC Certificate (02 Copies)
iv. 3 (Three) Copies of recent passport size photograph.
v. No Objection Certificate in case of in–service candidates.

NOTE
i. Incomplete application form will not be entertained.
ii. Application forms received after the expiry of due date will not be accepted.
Signature of the appilcant
Paste recent
passport
size photograph
Sl. NO……......……… RAJIV GANDHI UNIVERSITY
RONO HILLS, DOIMUKH-791 112
ARUNACHAL PRADESH
APPLICATION FORM FOR ADMISSION TO HALLS OF RESIDENCE
Halls of Residence :-…………………………..........................................................………
Session & Semester :-………………...........................................................…………..……
Department/Institute :-…………...........................................................……………..………
Course undertaking :-…….............................................................…………………..…….
Personal Details
1. Name: Mr/Miss/Mrs: :- ……………………………………………............……….……
2. Father’s /Husband’s Name: :-……………………………………………...........……….……..
3. Mother’s Name: :-……………………………………………...........……….……..
4. Marital status: Married Unmarried
5. Category ((Tick & specify) SC ST OBC Gen
6. (a) Permanent Address : :-………………………………………………………………………………….....
State/ Domicile :-…………………………………………………………………………...…….....
Contact: Landline (Home) Cell phone
(b) Local Guardian Name & Address :-…………………………………………………………………………...........
........…………………………………………………………………………....…
……...................................................................................................
Relationship :-…………………………......................................................................................................
Contact:Landline (Home) Cell Phone
Signature of Local Guardian
Other Details :
7. Name of the last examination passed :………………………....................... Total percentage:…....…….............
8. Name of the last institution attended :………………………................. Year :………….................……..............
9. Whether stayed in Hall or Residence earlier? Yes No
10. Whether employed in Govt./ Autonomous Inst. / Private Sector Services ? Yes No
11. Field of excellence and interest :…………………………………………………………………………........
12.Whether suffering from any communicable disease? ……………....……. Blood group……………………......
I, Mr./Miss/Mrs ....................................................................................................... hereby solemnly declare that the above furnished information is true to the best of my knowledge and belief. In the event of any fabricated or fake information found against me given proposition before or after the admission in the halls of residence, my application / residency shall be liable to reject and also forfeit my seat summarily without assigning any reason, thereof.
I have gone through all rules and regulations of the residence and shall bear allegiance to and abide by them.
For violation of any rules and regulations of the halls of residence in any point of time necessary action may be taken against me including expulsion from the halls of residence.
I am not in service in any of the government/ Autonomous Private Sectors/ Departments and Establishment till date.
Date. :- ……………………………..
Place :-………………………………
Signature of the applicant with date
RECOMMENDATION FROM THE HEAD/DIRECTOR OF THE DEPT. /INSTITUTE
Mr./Miss/Mrs ___________________________________________________ a Research Scholar (Ph.D /M.Phil scholar)/student of M.A/M.Sc/M.Com/MBA/MCA./M.Tech/BCA/.................................................... (I, II, III, IV, V, VI semester) has taken admission in the department/Institute of _______________________________________ on ________________________. His/her merit position in the selection list is ________________________
Date. :- ……………………
Place :-……………………
Signature and seal of the Head/Director of the Dept./Institute

FOR OFFICE USE ONLY
The Residence Admission Committee of the University has checked and verified the information furnished above and found it CORRECT/ INCORRECT. Thus, his /her application has been duly ACCEPTED / REJECTED for the admission into the ______________________________Halls of residence for the academic session 2013-14. The seat allotted to him /her is in Block ___________________Room_____________________Seat_____________________
Date :-……………
Signature and seal of Warden
UNDERTAKING