APPLICATION FORM 2017
Sr. No
Admission No.
(to be assigned by the Office)
APPLICATION FORM FOR STUDENTS
IMPORTANT NOTE:
1. The candidate should read the instructions given in the Information Brochure carefully before filling this Application Form
2. APPLICATION FORM AND SELF ADDRESSED ENVELOPE (COMPLETE IN ALL RESPECTS) FILLED IN BY THE CANDIDATE SHOULD
3. No column should be left blank. Write Not Applicable (N.A.) against the columns, which do not apply to you.
4. Please write the Codes for "Groups of the Course & Reservation Categories" from the list given at the end of Application Form.
6. Please write the Codes for "Groups of the Course & Reservation Categories" from the list given at the end of Application Form.
Group of the Course Group -I: Science
  Group-I: Commerce
Group-II: Arts
Teaching Sub.
   
   
     
RESERVATION CATEGORIES
1. Scheduled Caste SC
2. Backward Class Block-A BCA
BCB
3. (i)    (a) Physically Handicapped (for Blind) PHB
(b) Physically Handicapped (for locomotor disability)
(ii) SMP/ESM and their wards   ESM
(iii) Dependent of Freedom Fighters CFF
(iv) Dependent of the Martyrs of Haryana In Kargil War (Operation Vijay) KW
 
 
 
1. Name (in block letters as given in the degree)
2. Father's Name (in block letters)
3. Mother's Name (in block letters)
3. Email ID
3. Phone No.
4. Nationality  
5. (a) Sex [Write 'M' for 'Male' and 'F' for 'Female']:      
   (b) Date of Birth:                    
6. Do you want to be considered in any of the Reserved Categories as provided in the Admission Brochure  
 

If YES mention the name of the reserved Category in order of preference [write SC, BC (Block A or B) PH, ESM, FF as the case may be] (Please attach proof)

     
 
7. Correspondence Address:
PIN Code:
Permanent Address :
PIN Code:
8. ACADEMIC QUALIFICATIONS 
Exam.  Uni./Board Subjects  Year of Passing  Max. Marks   Marks obtained   %age of Marks 
Matric 
B.A./B.Sc./B.Com 
M.A./M.Sc./M.Com or equivalent
Any other Exam.
 
9. Teaching Experience: 
Name of School Post Held Date of Joining / Regular
Documents to be attached:
  • Attested Photocopies of Marks sheets of Matric and qualifying examinations.
  • Original Experience Certificate (as per Proforma given in Appendix-A).
  • Certificate pertaining to claim of reservation, if any.
  • Documents as mentioned in the Information Brochure
  • Self Addressed Envelope 9"x 4"
  • (Signature of the Gardation)  (Signature of the Applicant) 
     
    DECLARATION

    I, do hereby declare:
  • That I have carefully read the instructions given in the Information Brochure and the information as given above, including marks and percentage in column 11      above is correct and nothing has been concealed.
  • ii)     I undertake to observe proper standard of    academic conduct.
  • 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 a variance with    those of the previous year.
  • I shall abide by the Rules, Regulations and Ordinance in force, at present or that may be made thereafter by the M.D.U., Rohtak
  • and I shall not participate in    activities prejudicial    to discipline in the University or    in deviation from good conduct.
  • If any particulars/declaration as above are found to be incorrect the University may cancel my admission and I shall not have any right/claim for refund of any    fee/damage etc. whatsoever.
  • I shall faithfully carry out the instructions issued by the Directorate from time to time.
  • I hold myself responsible for due and prompt payment of fees and all other dues.
  • I understand that I cannot concurrently be enrolled for more than one full time courses of studies at a time.
  •  
    PLACE:
    DATE:    (Signature of the Applicant)

    FOR OFFICE USE ONLY (To be left blank)
    Checked and found: 1.    Eligible
    2.    Not eligible: Reason

    Clerk                                                 Assistant                                                    Superintendent

    Diary No: