GAUHATI UNIVERSITY

PHOTO
Gopinath Bardoloi Nagar, Guwahati -781014
Application Form for Admission under N.C.C. or N.S.S. Quota
Session: 2019-2020
2020-2021
(To be submitted in respective Department)

Reference Online Application form No………………………………………………………………………………………………………………………….

A.Course Applied for………………………………………………………… B. Subject Applied for………………………………………………………..

C. Subject(s) offered in TDC Course: Major………………………………………..General……………………………..………………………………

D. Marks obtained in the subject (Major/General) in TDC Examination 20……….

Total……………………………………... Percentage……………………………………..

1. Name of the Applicant in full (in BLOCK CAPITAL)………………………………………………………………………………………………

2. Permanent Address of Parent Father/ Guardian Name…………………………………………………………………………………….
Town/Vill/Area:……………………………………………Mouza……………………………...............P.O………………………………………
P.S…………………………………………………Dist……………………………………………….State………………………………………………….
PIN…………………………………………………Phone No.(s)…………………………………………………………………………………………….
3. Present Address of Parent Father/ Guardian Name………………………………………………………………………………………….
Town/Vill/Area:……………………………………………Mouza……………………………...............P.O………………………………………
P.S…………………………………………………Dist……………………………………………….State………………………………………………….
PIN…………………………………………………Phone No.(s)…………………………………………………………………………………………….
4. Academic Qualification (TDC onward): (Attested Photocopy of the Marksheet to be attached)
Examination Passed Year of Division/Class Subject in Major Marks obtained in % of marks in College/Institution
Passing /General Major /General Major /General
Subject Subject
B.A./B.Sc./B.Com.
Other Course
5. NCC/NSS proficiency in the last 3 years preceding graduation:
NCC 1. NCC Certificate Details: B C (Tick whichever is applicable)
2. Date and year of award of Certificate

NSS 1. National Integration Camp Details

2. Date and year of award of Certificate

6. Details of NCC/NSS certificates obtained in the last 3 years preceding graduation:

(Attested copies of Certificates to be attached)
1…………………………………………………………………….…………5……………………………………………………………………………………
2…………………………………………………………………….…………6……………………………………………………………………………………
3…………………………………………………………………….…………7……………………………………………………………………………………
4…………………………………………………………………….…………8……………………………………………………………………………………

DECLARATION BY THE APPLICANT

I hereby declare that the informations furnished above is correct and complete to the best of my
knowledge and belief. If any of the information given above is found to be incorrect, my admission will be liable
to be cancelled and I shall be liable to disciplinary action as may be decided upon by the Gauhati University
Authority.

Countersignature of the Parent/Guardian Signature of the applicant

Date…………………………… Date………………………………
OFFICE USE
Provisionally selected under NCC/NSS Quota into:
Course…………………………………………………..Subject………………………………………….Roll No………………………………….

ADMITTED

Signature Signature
Head of the Department Secretary, University Classes
Gauhati University Gauhati University