GOVERNMENT COLLEGENAGROTA BAGWAN, DIST. KANGRA (H.P.) -176047

ADMISSION FORM (2020-21)

For Office use only

Fee Receipt No. ____________________________ Roll No. _____________________________

Date _____________________________________ Subject Allotted _______________________

Signature ____________________________

Attach Latest

Photograph

and

sign across

1. Name of Candidate (in block letters) _____________________________________________________

2. Father’s Name ________________________ 3. Mother’s Name __________________________

4. Gender (Male/Female) ___________ 5. Date of Birth (DD/MM/YYYY)

6. Course Name (BA / BSC / BCOM / MA /. Other ) _____________ 7. Year/Semester _____________

8. Category you belong to (General/ SC/ ST/ OBC/ IRDP (Attach Certificate)_________________________

9. University Registration No. ______________________ 10. Blood Group ______________________

11. Last Year College Roll No _______________________ 12. University Roll No. _________________

13. Student’s Email ID(Compulsory) __________________ 14. Aadhar Card No. ___________________

15. Bank Account No. _____________________ IFSC Code ____________ Branch Name ______________

16. Permanent Address ___________________________________________________________________

___________________________________________________________________

Phone No. (1) ___________________________ (2) ______________________________

17. Guardian’s Name & Address ____________________________________________________________

___________________________________________________________________

Phone No. (1) ___________________________ (2) ______________________________

18. Do you belong to Minority Community (Sikh/Muslim/Christian/Buddhist /Parsis / if other (mention) ________________

19. Name Class & Roll No of Brother / Sister Currently studying in the College ________________________

___________________________________________________________________________________

20. Academic Record (Attach Signed Copies of Certificates) 10+2 onwards

ExamPassed

Board/UniversityRoll No. Year Maximum

MarksMarks

ObtainedPercentage/CGPA

School/CollegeName

21. Subject Specific choice for 1st year students :

Subject 1 __________________ Subject 2 ____________________ Subject 3____________________

22. Course Combination (for 2nd Year and 3rd Year students) :

1_______________ 2_______________ 3_______________ 4_______________ 5_______________

23. Course Combination for M.A./M.Sc./M.COM. students :

1_______________ 2_______________ 3_______________ 4_______________ 5_______________

Student’s Email ID: ________________________ Phone No. _____________________

i) I am applying for admission with the approval of my parents / Guardian.ii) I will abide by the University/College rules and regulations. I have gone through the rules and regulations

regarding ragging and discipline of the University/College (given in the College Prospectus and hereby solemnly affirm that I will not indulge in any act of ragging/indiscipline and that if I an found guilty of such offences as are covered under these rules, the decision of the college authorities will be binding on me.

iii) All college dues will be paid in time.iv) I will be regular in my class and will compete 75% of the lectures delivered, failing which/will not be

entitled to take University examination.v) I will appear in the house examinations and fulfill all the conditions laid down by the University in this

respect.vi) I hereby promise not to take part in political activities of any kind as a student.vii) My admission will be provisional till approval by the University.

Date Signature of Applicant

DECLARATION BY THE APPLICANT

DECLARATION BY FATHER/GUARDIAN

I Father/Guardian of Mr. / Ms. _____________________________________________________solemnly

declare that my son/daughter/ward is seeking admission in class with my permission and I promise to pay all

dues regularly as and when demanded. He / She will not take part in any political subversive, agitations, ragging

activity or use any tobacco products in case he/she is involved in any of the above activities. I shall abide by the

action taken by the College authorities. I undertake the responsibility for the good behaviour and conduct of my

son/daughter/ward. I shall personally look after his/her regularity in attendance, progress in studies and general

behaviour and keep in touch with the Principal/Class Teachers regarding all these.

* (Guardian means only blood relation but not a student of this institution)

Date ..................................... Signature of Applicant Signature of Father/Guardian

(Before Admission Committee)

ANTI-RAGGING AFFIDAVIT

Vide H.P. University Notification No. 4-39/2012-HPU (Acad) dated 25th My, 2010, regarding curbing

menace of ragging in Educational Institutions, the parent of the students are required to submit the affidavit at

the time of admission containing undertaking as mentioned below :

I ___________________________ Father/Mother/Guardian of ____________________________

seeking admission to the class __________________ ensure you that my son/daughter/ward will not indulge in

any act of ragging or indiscipline in the college campus / hostel / anywhere outside the college campus in case of

any such violation strict disciplinary action may be taken against him/her as per the Ordinance issued by H.P.

Govt. and I will not interfere in any way in the action taken against my son / daughter / ward.

Date ________________________ Signature of Parent / Guardian

Certified that all the particulars mentioned in the form and other documents have been carefully checked from

original certificates and found in order and the applicant has signed before me. The applicant is

RECOMMENDED / NOT RECOMMENDED FOR ADMISSION.

Signature of Members 1 ___________________ 2__________________ 3___________________

Date _________________ Signature of Convener Signature of Principal/Convener

(Admission Committee) (Final Admission Committee)

(Admission / Provisionally Granted)

1. Father’s / Guardian’s Name ..........................................................................................

2. Occupation ..........................................................................................

3. Name of Student/Ward ..........................................................................................

(In Block Letters) ..........................................................................................

4. Class Roll No ..........................................................................................

5. Permanent Home Address ..........................................................................................

with Phone/Mob. No ..........................................................................................

6. Present Address of Father/Guardian ..........................................................................................

with Phone/Mob. No. ..........................................................................................

7. Father’s / Guardian’s Occupation ..........................................................................................

8. Name of Brother/Sister Studying ..........................................................................................

in the college (with Class & Roll No.) ..........................................................................................

UNDERTAKING

Kindly enroll me as a member of the Parent Teacher Association for the session 2020-21. I

promise to abide by the rules and regulations of the Association as at present and amended from time to

time. I also promise to attend all the meetings of PTA convened by the college authorities. My donations

of PTA are voluntary.

.................................................... ....................................................

Signature of Student Signature of Parent/Guardian

Note : i) Only parents can be member of PTA.

ii) Guardian means only blood relation but not a student of this college.

PARENT TEACHER ASSOCIATION(Govt. College, Nagrota Bagwan)

Membership Form

(2020-21)

Paste

Photograph

of Parents/

Guardians

Dist. Kangra (H.P.)