FORM NO :- ............. 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
                           
                           
                                                                                                                                                                                                                       APPLICATION FORM                                                                                                                                                                                                                                                                                                                                        
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
                                                                                                                                    DEPARTMENT OF SANSKRIT                                                                                                                                                                                                                                                                                                                                                                                                            
                                                                                                                                                                                                                                                                                                                                                          PHONE: 1. 9427407451 2. 9638831518  
                                                                                                                                    KRANTIGURU SHYAMJI KRISHNA VERMA KACHCHH UNIVERSITY 
                           
                                                                                                                                                                                                                 In Collaboration with 
                                                                                                  Name of Institute: 
                                                                                                   
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
                           
                                                                                                                                                                                                  NAME OF COURSE                                                                                                                                                                                                                                       FEES 
                                                                                                      CERTIFICATE COURSE IN SPOKEN SANSKRIT(BASIC/ADVANCE)  1,000/- 
                                                                                                               
                                                                                            ❖ STUDENT DETAILS: 
                                                                                                               
                                        (As it appears on HSC mark sheet) 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
                                                   1                                                NAME 
                                                                                                                                                                                                                                                                                                                          
                                                   2                                        FATHER'S NAME                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
                                                                                                                                                                                                                                                                                                                          
                                                   3                                      SEX (Tick √)                                                                       o                                                  MALE                                                o                                          FEMALE 
                                                                                                                                                                                                                                                                                                                          
                                                   4                          DATE OF BIRTH (DD/MM/YYYY)                                                                                                                                                                   /                                                   /                                                                        
                                                                                                                                                                                                                                                                                                                          
                                                   5                             COMMUNICATION                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
                                                                                                                ADDRESS                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
                                                                                         CITY /TOWN -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
                                                                                                 PIN CODE -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
                                                                                                                                                                                                                                                                                                                          
                                             6(A)  PHONE NO.                                                                                                                                                                                                                                                                                       
                                                                                                                                                                                                                                                                                                                          
                                              6(B)  E-MAIL ID                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
                                                                                                                                                                                                                                                                                                                          
                                                   7                                         RESERVATION                                                                                                o                                                       SC                                                     o                                                      OBC 
                                                                             CATEGORY  (Tick √)  o                                                                                                                                                             ST                                                      o                                                OPEN 
                                                                                                                                                                                                                                                                                                                          
                                                   8                            NATIONALITY                                                                                                                                                                                                                                                                                                                                                                                                                                      
                                                                                                                                                                                                                                                                                                                          
                                                   9                                                        LAST PASSING                                                                                o                                               SCIENCE                                                                  o                                                                                                   ARTS 
                                                                                                                                                                   TH
                                                                                                 STANDARD (5  STD.  o                                                                                                                            COMMERCE                                                                        o                                      OTHER:                                                                                                   
                                                                                                                  PASS MINIMUM) 
                                                                                                                                                                                                                                                                                                                          
                                                     10                                          RESULT                                                                              NAME OF                                                           YEAR OF                                            TOTAL MARKS                                                                             TOTAL                                                   PERCENTAGE / 
                                                                                               DETAILS                                                                           INSTITUTE                                                             PASSING                                                     OBTAINED                                                                      MARKS                                                           GRADE/CGPA 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
                                                                                                                                                                                                                                                                                                                          
                                                     11                                                                                            HAVE YOU APPLIED FOR ANY OTHER INSTITUTE/COURSE? 
                                                                                       INSTITUTE :                                                                                                                                                                                                                                                                                                                                                                                                                               
                                                                                    UNIVERSITY :                                                                                                                                                                                                                                                                                                                                                                                                                                 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            PAGE 1 OF 3 
                 ❖ COURSE SUBJECT DETAILS: 
                       
                      दीक्षा - 1 
                                                                                     
                                                                                     
                                                                                     
                                                                                     
                       
                 ❖ RULES : 
                        
                                                                                           th
           •    Eligibility for Admission to the Course is minimum 5  Std. pass. 
           •    Course syllabus (Study material) will be in Sanskrit language only. Student  have to 
                write Assignment / Answer Paper in exam in Sanskrit language only. 
           •    Students have to attend the Course at the place selected by the organization for Theory and Viva. 
           •    Regular presence is must during course(80% Compulsory) .  
           •    Insufficient presence will be lead to cancellation of admission in exam. 
           •     If any misbehavior found during the course the student will be subject to action as found appropriate by the 
                 Organization. & KSKV KACHCHH University 
           •    The entire Course rules must strictly followed by students. 
           •    Any other certificate(s) as specified by the university / institute from time to time need to be provided by the 
                candidate. 
         
         
         
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
                                                                                                                                                                              
         
                                                                                                                                                                              
                                                            PAGE 2 OF 3 
        
                                                        DECLARATION BY THE APPLICANT 
        
         I………………………………………………………………….HEREBY   APPLY   FOR   ADMISSION   IN   CERTIFICATE COURSE 
         IN  SPOKEN  SANSKRIT  (BASIC/ADVANCE)  PROGRAM  AT  KRANTIGURU  SHYAMJI  KRISHNA  VERMA 
         KACHCHH UNIVERSITY IN ACADEMIC YEAR ............................... I DECLARE THAT I HAVE READ THE RULES 
         AND REGULATIONS FOR THIS COURSE AND I SHALL ABIDE THE SAME. I DECLARE THAT ALL THE ABOVE 
         MENTIONED  INFORMATION  IS TRUE.  IF ANYTHING IS FOUND TO BE UNTRUE, MY APPLICATION AND/OR 
         ADMISSION IS LIABLE TO BE CANCELLED. 
        
         PLACE: 
         DATE:                                                                                           SIGNATURE OF APPLICANT 
                                                             FOR OFFICE USE ONLY 
        
                           Sr.                                    DOCUMENT                                         TICK √ 
                            1.    BIRTH CERTIFICATE                                                               
                            2.   SCHOOL LEAVING CERTIFICATE / BONAFIDE CERTIFICATE                                
                            3.   SC/ST/ OBC AND NON-CREAMYLAYER CERTIFICATE (IF APPLICABLE)                       
                            4.   RESULT OF LAST PASSING EXAM                                                      
        
        
         CHECKED AND ACCEPTED BY: 
        
                                                                                                           SIGNATURE……………………..…. 
        
        
        
                    DEPARTMENT OF SANSKRIT, KRANTIGURU SHYAMJI KRISHNA VERMA KACHCHH UNIVERSITY 
                                                                                                                PHONE: 02832-235031 
                                                                            
                                                                                                                                    
        
                                                   COUNTER FOIL / RECEIPT OF APPLICATION FORM 
        
         ADMISSION  FORM NO. …………….. RECEIVED FROM ………………………………………………….. ON ……/……/…........…. WITH  
         ADMISSION IN ……………………………………………………………………………………………………………… 
        
        
        
                                                                                                          SIGNATURE:…………………. 
        
                                                                                                                                              
                                                                                                                                              
                                                                                                                                              
                                                                                                                                              
                                                                                                                                              
                                                                                                                                              
                                                                                                                                              
                                                                                                                                              
                                                                                                                                              
                                                                                                                                              
                                                                                                                                              
                                                                                                                                              
                                                                                                                                              
                                                                                                                                              
                                                                                                                                              
                                                                                                                                PAGE 3 OF 3