APPLICATION CUM ADMISSION FORM

Tick ( ) the Programme (box) in which admission is sought:

GRADUATE PROGRAMS

B.Tech (4 years Programme)

CSE (Computer Science & Engg.) ECE (Electronics & Communication Engg.) ME (Mechanical Engineering)

EE (Electrical Engg.) CE (Civil Engg.)

BBA BCA BHM B.Com B.Sc. Hons (Physics) B.Sc. Hons (Chemistry) B. A.

B. Pharmacy*

POST- GRADUATE PROGRAMS M.Tech (2 years Programme)

CSE ECE CE ME EE

M.Sc (Physics) M.Sc (Chemistry) M.Sc (Mathematics) M.Sc (Zoology)

MA Education M. Com MCA

RESEARCH PROGRAMS

M.Phil (Physics) M.Phil (Chemistry) M.Phil (Mathematics) M.Phil (Management)

Ph.D (Physics) Ph.D (Chemistry) Ph.D (Management)

PERSONAL INFORMATION

Name (in capitals) …………………………………………………………………………………….....

Father’s Name (in capitals) ………………………………………………………………………………………..

Father’s Occupation: Service Business Others

Mother’s Name (in capitals) ………………………………………………………...................................................

Date of Birth …/…./……… SEX: Male Female

Address for Correspondence …………………………………………………………………………………………….

Permanent Address ………………………………………………………………………………………………………

Telephone No. …………………………. Mobile No …………………………………..

Mobile No. Father/Guardian ……………………………………. State of Domicile …………………………………..

Email ID ………………………………………………………….. Blood Group ………….

Category under which admission is Sought: General SC/ST OBC OTHERS

Have you ever been punished by a School Board/ University/ Civil Court: Yes NO

Affix

Passport

Size

Photograph

Registration No

* Subject to Approval from PCI.

If Yes give detail: …………………………………………………………………………………………………………………

Is there any gap in studies after Metric Onward: Yes NO

If Yes, give details: ……………………………………………………………………………………………………………..

DETAIL REGARDING ENTERANCE/ ADMISSION TEST JEE (IIT)/HPCET/ CAT/MAT Roll No. ……………………………… All India Rank ………………………………..

ANY OTHER TEST

Name of the Test ……………………………………………….

Roll No. ………………………………………………. Rank ………………………………

EDUCATION BACKGROUND Examination Passed Board/University Year of Passing Marks Obtained/Max.

Marks

Marks%/Division

Matric

10+2

Graduation (specify)

Post-Graduation

Any Other

Whether Hostel Required: Yes NO Whether Transport Required: Yes NO

Undertaking:

I declare that the entires made by me in the above form are correct to the best of my knowledge. I undertake that I shall not

include in any form of ragging during my entire stay in the University. If found guilty, I shall be liable to punishment under

Prohibition of Ragging Act 2009 promulgated by Govt. of Himachal Pradesh or related laws. And that I have not been

involved in ragging in the past. I am conscious that if any of the entires are found to be incorrect, my admission is liable to be

cancelled.

Place …………………

Date …………………. Signature of the Student Signature of Parent/Guardian

Note: The Application form complete in every respect alongwith photocopy of Admit Card & Score Card of Admission Test and

attested copies of certificates/testimonials from matric onwards & 4 recent passport size colored photographs should be

attached.

Certificates to be submitted: (Tick the Submitted Document)

10th

(Matric) / DOB Migration Certificate

12th

(Plus Two) Category Certificate

Last Qualified Exam Gap Affidavit

Character Certificate Anti-Ragging Affidavit

Bonafide Certificate Passport Photos (04)

Aadhaar Card

FOR OFFICE USE

Admission Committee (Signature of Ad. Assistant)……………………

Admit / Not to be Admitted

i) Member-1, ………, Sign. …… ii) Member-2,………., Sign ……… iii) Director Admissions ………, Sign …….……….

(Name) (Name) (Name)

Dean Academics………………, Sign ……………..

(Name)