Form No.

Pacific Hills, Pratap Nagar Extn., Airport Road, Udaipur Recent Photograph
of 35mm x 45mm
Admission Form to be pasted on
hard print
Session 20 - 20

Programme Applied for _________________________________________________________________

(For Programme see the list)
Regular Executive Batch

Faculty _______________________________________ Year / Semester_________________________

I PERSONAL INFORMATION:

(a) Name __________________________________________________ Date of Birth ___/ __/ __

Name (In Hindi) __________________________________________ Gender _______________

Student’s Mobile No(s). ___________________________________________________________

E-mail Id_______________________________________________________________________

Current Address _________________________________________________________________

_________________________________________________________________

Land Line No. with Code__________________________________________________________

Permanent Address______________________________________________________________

________________________________________________________________

Land Line No. with Code__________________________________________________________

Category: GEN SC ST

OBC Physically Handicapped Minority

Father’s Name_______________________________________ Occupation _________________

E-mail Id___________________________________ Contact No.__________________________

Mother’s Name ______________________________________Occupation_________________

Family Income_______________________

II EDUCATIONAL INFORMATION:

Examination Board / University College / Institute Year Percentage

XII

Graduation
 Post Graduation

Computer Literacy

Others

III EMPLOYMENT HISTORY

Work Experience: Yes No

(If yes, total experience: Years_____________________Months__________________)

Organization / Company Details: (Starting from the latest)

Name & Address of the Company Designation Duration

III ACHIEVEMENTS OF COCURRICULAR ACTIVITIES: ____________________________________

____________________________________________________________________________

Name & Address of two reputed persons who can vouch for competence and character

1. ________________________________ 2.______________________________

_________________________________ ______________________________

_________________________________ _______________________________

Phone: ____________________________ Phone: __________________________

Attachments: Tick the following:

Examination Original Copy Attested Photocopy Undertaking

X (Marksheet & Certificate)

XII (Marksheet & Certificate)

Graduation (Marksheets)
Certificate of Category
Transfer Certificate

Migration Certificate
Others

FOR OFFICE USE

Fee received Rs. _____________________( In words)__________________________________________

Date_______________________________ Receipt No. ________________________________________

Signature of Accounts Officer

Form checked and verified by ______________________________________ on ___________________

Office Administrator Admission Incharge

Declaration:

I ________________________________D/o S/o hereby declare that

1. I accept & agree to follow and abide by the rules and regulations of the university.
2. I shall not indulge in any matter that comes under ragging with any fellow mates, staff or faculty member
as individual or in a group.
3. Incase I am found disobeying the rules & regulations at anytime, university authority has the right to take
a disciplinary action against me, which could either lead to the extent of rustication from the university. I
and my parents / guardian shall not interfere on the action taken by the university authority in such
matter.
4. I shall have no objection if my photograph / voice, while taking part in the university, appears in any
presentation of the university.
5. I and my parents / guardian shall be responsible for the payment of all the fees & other charges/fines
whenever demanded.
6. I shall abide by the examination rules and shall proceed accordingly.
7. I shall not use mobile, modem, electric heater and such other items which are whenever prohibited by the
university.
8. I hereby declare that Pacific University shall not be responsible for any mishappening on my part during
the course of my study (on campus or off campus) in the University / Industrial Visits / Trainings / Tours /
Transport etc. I and also my dependents or next of kin in such a case shall not claim any compensation for
my damages or disability.

Date: ……………………………………………..
Place: …………………………………………… Student’s Signature

UNDERTAKING TO BE SIGNED BY THE PARENT / GUARDIAN

I ______________________________________________ do hereby solemnly affirm and undertake that

1. My daughter / son _______________________________________ has submitted this application form for

admission in Academics and Hostel Accommodation / Day boarder’s facility with my permission and that I
shall be responsible for her / his good conduct as a student of the university and adhere to the provisions
of the Pacific University Ordinances / Regulations and Rules / Orders/ Decisions etc.
2. I also declare that no case has been pending against my daughter / son in any Civil / Criminal Court of the
Country.
3. I endorse all sorts of undertaking by my daughter / son.

Date: ……………………………………………..

Place: …………………………………………… Parent’s Signature

LIST OF PROGRAMMES:

A. Faculty of Management Studies :

1. B.Com-MBA Integrated Programme

2. B.Com-MBA Integrated Programme synchronized with CA curriculum
3. B.Com-MBA Integrated Programme synchronized with CS curriculum
4. BBM-MBA Integrated Programme
5. BBM-MBA Integrated Programme synchronized with CS curriculum
6. BBM-MBA Integrated Programme synchronized with CA curriculum
7. MBA – Insurance Management and Actuarial Science (2 years)
8. MBA + M.Sc. Actuarial Sciences (Dual Degree 3 years)
9. M.Sc. Actuarial Science (2 years)
10. PG Diploma in Financial Mathematics & Behavioural Finance (1 year)
11. PG Diploma in Insurance Management (1 year)
12. MBA – Hospital Administration (2 years)
13. Master of Hospital Administration (2 years)
14. PG Diploma in International Marketing
15. PG Diploma in Human Resource Management
16. PG Diploma in Financial Analysis and Portfolio Management
17. PG Diploma in Finance and control
18. Ph.D

B. Faculty of Engineering

1. B.Tech (4 yrs), D2D,

2. M.Tech (2 years)
3. Ph.D

There are following specializations in Engineering :

a. Electronics & Communication Engineering.
b. Computer Science Engineering.
c. Information Technology
d. Civil Engineering
e. Electrical Engineering
f. Electrical & Electronics Engineering
g. Mechanical Engineering
4. Master of Computer Applications (MCA)

C. Faculty of Pharmacy

1. B.Pharma (4 yrs)
2. M.Pharma (2 years)
a. Pharmaceutics
b. Pharmaceutical Analysis
c. Pharmacology
 d. Pharmaceutical Chemistry
3. Ph. D.

D. Faculty of Hotel Management & Catering Technology

1. BHMCT (4 years)
2. B. Sc. In Hotel Management (3 years)
3. DHM (2 years)
4. TD in Hotel Management (1 year)
5. DHM (FP/F & B/FO/HK) (1 year)

E. Faculty of Dental Sciences

1. BDS (5 years)
2. MDS (3 years)
3. Dental Mechanics (D.M.) (1 year Diploma)
4. Dental Hygienist (D.H.) (1 year Diploma)

F. Media & Mass Communication

1. Media and Mass Communication

a. 3/ 6 months course in TV Journalism
b. 3/ 6 months course in Radio Journalism
c. 3/ 6 months course in Video Editting
d. 6 months course in Print Media
e. 1 yr.PG Diploma in Journalism & Mass communication
f. BJMC (3 years) Bachelors in Journalism & Mass communication
g. MJMC (2 years) Masters in Journalism & Mass communication
2. Animation
a. 3/6 months in 2D Animation
b. 6 months course in 3D Animation
c. 1 yr dip/ 2 yr adv.dip in animation
d. B.Sc. Animation (2yrs)
e. M.Sc. Animation(3 yrs)

G. Fashion Designing

1. Fashion designing
a. 3/6 months certificate
b. 1 yr diploma , 2yr Adv. Diploma
c. B.Sc (3yrs), M.Sc (2 yrs)
2. Jewellery Designing
a. 3/6 months Certificate
b. 1yr. diploma
3. Textile Designing
a. 3/6 months certificate
b. 1 yr diploma , 2yr Adv. Diploma
c. B.Sc (3yrs)
4. Interior Designing
 a. 3/6 months certificate
b. 1 yr diploma , 2yr Adv. Diploma, B.Sc (3yrs)
5. Fine Arts and Graphics
a. 1 yr diploma , 2yr Adv. Diploma

Download this form, take a printout and send the hard copy of the same, along with the requisite bank
draft of Rs. 200/- in favor of “Pacific University” payable at Udaipur, after affixing the passport size
photograph in the space provided for, at the address given below. The form can also be submitted at the
University Office in which case, cash Rs. 200/- has to be deposited in the cash section.

Admission Coordinator
Pacific University,
Pacific Hills, Pratap Nagar Extension,
Airport Road, UDAIPUR – 313003.
(Rajasthan)