DOWNLOADED FORM
NAGALAND UNIVERSITY
HEADQUARTERS LUMAMI
(A Central University established by the Act of Parliament No.35 of 1989)
APPLICATION FORM FOR ADMISSION
(M.Sc/M.A/M.Com & Ph.D)
(Strike out whichever is not applicable)
(The candidate must fill-up all the columns 1-14 legibily)
ACADEMIC SESSION
2013-14
Department: ............................................Course: .............. Headquarters/Campus: ..........................
1. Name of the Applicant (in Block Letters) : ........................................................................
2. Sex and Marital status : ........................................................................
3. (a) Father’s Name : ........................................................................
(b)Mother’s Name : ........................................................................
4. (a) Permanent Address : ........................................................................
: ........................................................................
: ........................................................................
(b)Address for correspondence : ........................................................................
: ........................................................................
: ........................................................................
(a) Telephone No/Mobile No. : .......................................................................
(b) E-mail ID, if any : .......................................................................
5. Date of Birth (as per HSLC) : .......................................................................
6. Nationality : .......................................................................
7. Category (SC/ST/GEN/OBC/Others) : Yes/No (if yes, attached certificate)
8. Are you employed? : Yes/No (if yes, attached NOC from the employer)
9. (a) Name of the College/University last :
Attended (attached certificates)
(b)Course completed :
(c)Registration No. & Year :
10. Educational Qualification :
Examination
passed
Board/
University
Year of
passing
Total
marks
Marks
secured
percentage Division/
Class
Subject(s)
HSLC
10+2
B.A/B.Sc/B.Com
Gen. Hons.
M.A/M.Sc/M.Com
Others
(Attached attested copies of the certificates in support of the qualifications)
Affix attested
recent
passport size
photo
11.Are you a receipent of any Scholarship/Award/Distinction? : Yes/No (if yes attached
certificate)
12.Have you ever been disqualified or debarred from any : Yes/No (if yes, give details)
Examinations before?
13.Are you physically challenged : Yes/No (is yes, attached
Medical Certificates)
14.Co-curricular activities, if any (attached certificates)
_______________________________________________________________________________
1. All the entries must be made in the candidates’s own handwriting.
2. The form should be complete in all respects.
3. The form should be submitted to the respective Head of Department.
4. Incomplete form is liable to be rejected.
DECLARATION BY THE APPLICANT AND THE GUARDIAN
A. I do hereby declare that the entries made by me in this form are correct to the best of my knowledge
and belief. If any entry is found to be false/incorrect, I am aware that my admission will be liable to
cancelled.
B. I undertake to abide by the rules of the University in force from time to time.
Signature of the Applicant Countersigned by Parent/Guardian
Date: Date:
_______________________________________________________________________________
Certified that all the entries in the application are checked and found in order. Eligible/Not-Eligible
for admission.
Name and Signature Name and Signature
of the Head of the Deparment of the Dean of the School
Date: Date: