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Hostel Application FORM

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138 views

Hostel Application FORM

Nothing

Uploaded by

pankajsingh02277
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Chhatrapati Shahu Ji Maharaj University , Kanpur

Application For Admission in Hostel Session 20_ _ - 20_ _


( Note : Don’t leave any field blank . Incomplete application will not be considered)

1. Student Name (in HINDI): ………………………………………………………………………………………………………..


Student Name (in ENGLISH): ……………………………………………………………………………………………………
2. Father’s Name : ……………………………………………………………………………………………………………………. Photo
3. Mother’s Name: ……………………………………………………………………………………………………………………..
4. Class: …………………………… Branch/Department……………………… Ist Year Entrance Rank ……………
5. Permanent Address: …………………………………………………………………………………………………………………………………………….
Pin Code …………………………………
Attach Current Resident Proof ……………………………………………………………………………………………………………………………..
6. Local Guardian’s Name: …………………………………………………. Relation…………………………………………………………………….
7. Local Address ……………………………………………………………………………………………………………………………………………………….
Pin Code …………………………………
8. General/ SC/ST/OBC …………………..
(Attach Certificate)
9. Attach Educational Marksheet &Certificate ………………………………………………………………………………………………………….
10. Mobile Number of Student ……………………… Father & Guardian Mobile number……………………………………………………
11. Fee Receipt number and date (attach photocopy)………………………………………………………………………………………………….

Father/Guardian Signature Signature of Student

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Approval of Director/Head

Student………………………………………………….. Son/Daughter Shri …………………………………………………………………………………………..

Class …………………………… part…………. in Department/Institute…………………………………………………………………………………………..

has admitted , his behavior is satisfactory. I approved his/her admission in the Hostel.

Date …………………………………. Sign & Stamp of HOD

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(To be filled by office)

12. Date of submission of Hostel Application Form …………………………………………………………………………………………………….


13. Date of receiving Hostel fees/Chalan …………………………….. Chalan No. …………………………………………………………………
14. Hostel Fees and Mess Fees submit respectively Rs ……………… Rs……………… Date……………………………………………………
15. Name of the Hostel………………………………………………………………………………………………………………………………………………..
16. Room Number of the Hostel ………………………………………………………………………………………………………………………………….

Sign of Clerk Sign of Warden

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