Appl. No.

: UNIVERSITY OF MYSORE
YUVARAJA’S COLLEGE
JLB Road, Mysuru - 570 005, Karnataka, India
(Consituent Autonomous College with Potential for Excellence)
(Accredited ‘A’ grade with CGPA 3.34 by NAAC)
FORM OF APPLICATION FOR ADMISSION TO B.Sc, B.C.A. & B.B.A DEGREE COURSES
AS PER NATIONAL EDUCATIONAL SCHEME 2021-22
1. Name of the Candidate :
(in Block Letters) (Put initials last)

Day Month Year Photo

2. Date of Birth (as in S.S.L.C. marks card) (Passport Size)

3. Sex : Male Female

4. Name of Parent / Guardian ...............................................................................................................................................................

Student mobile No. and Email ID Address ...........................................................................................................................................
................................................................................................................................................................................................................
................................................................................................................................................................................................................
5. Annual Income of Parent/Guardian (in figures)...........................in words .......................................................................................
(Attach copy of Income Certificate issued by competent authority on or after 1-4-2020 or Valid Certificate.)

Qualifying Examination Examinaiton Month Year Reg. No. Result with Class
First Appearance

Second Appearance

7. Subjects offered and Marks obtained in the Pre-University/qualifying Examination :

Group-I: (a) Langauges: 1. ............................/100 2. ............................/100

Group-II: (b) Optionals: A..................../100 B..................../100 C..................../100 D................../100 Total for 400.................
8. Medium of Instruction (Tick): Kannada....................... English.........................
9. State whether physically handicapped : Yes / No

10 Category (Tick) : GM SC ST CAT I IIA IIB IIIA IIIB Special Quota

DECLARATION
1. I have read the information contained in NEP regulations.
2. I hereby solemnly and sincerely affirm that the statement made and information furnished in my application form and in the
enclosures submitted by me are true. Should it, however, be found that any information furnished therein is untrue in material
particulars, I realize that I am liable to criminal prosecution and the seat given to me shall be liable to be forfeited.
3. I agree to abide by the Regulations and Ordinances of the University for University for maintenance of discipline in the
College/Department/Institute/Hostel/Lab.
4. I will neither involve myself in any unlawful/provocative/communal/anti-social activities nor cause any harm to any fellow
student/teacher/official. In case I am found guilty of any of the above act, I understand that I am liable for punishment under
Mysore University disciplinary control ordinances, 1989.
5. I also agree not to involve myself in unlawful activities such as ragging and causing any damage to College property.
6. I do not claim refund of the admission fee paid to the college in case of cancellation of my admission for any reason.
7. I declare that, I always abide by the NEP regulations of Government of Karnataka and University of Mysore made by time to time.

Place :
Date : Signature of Applicant
Applicant’s Specimen Signature : 1) ...........................................2) ...........................................3) ...........................................
The information furnished by my ward is true to the best of my knowledge.
Signature of Parent
INSTRUCTIONS :
1. For claiming seat under quota, required certificates should be attached.
2. Three stamp-sized photos & 2 self addressed stamped envelopes should be submitted at the time of admission.

Submitted the application form

ACKNOWLEDGEMENT
Sl. No.

No..................................Dated............................With necessary enclosures (Xerox Copies)

1. S.S.L.C. & P.U.C. Marks Cards ............................................ 2. Caste

Certificate ....................................................................
3. Sports .................................................... 4. Uni. Emp. Certificate ..................................... 5. Any other ..............................

Verified and Checked : .......................................................... Signature of the Verifying Authority

 2

OFFICE USE ONLY

Receipt No. Date Amount

1 Application Fee

Receipt No. Date Amount

2 Admission Fee

Numbers Date
3 Admission No. & Date

4 Combinations to which students is admitted

5 Category of the Candidate

Scheme A Scheme B
6 Admitted Under to

Principal’s Remarks ...........................................................

Signature of the Principal

with Seal