KRGAdmision Form 2015-16

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'kkldh; deykjktk dU;k LukrdksÙkj Lo’kklh egkfo|ky; Xokfy;j ¼e0iz0½

uohu QksVks
pLik djsAa
izzos'k vkosnu i=

1- vkosnd dk iwjk uke ¼fgUnh es½a


2- vkosnd dk iwjk uke ¼vaxt
zs h esa dsfiVy ySVlZ½
Full Name of Applicant (In English Capital Letters)
3- firk dk uke ¼Father’s: Name) …………..………………………………………………..
ekrk dk uke (Mother’s: Name) ……………………………………………...……………..
4- LFkkuh; iw.kZ irk ¼Local Address) --------------------------------------------------------------------------------------------------------------------------------------------
---- ………………………………………………………fiu dksM………………………...
5- Ekksckby u- (Mobile No)…………………………..E-Mail …………………………………
6- LFkk;h iw.kZ irk % -¼Permanent Address)……………………………………………………......
……………………………………………………………………………………………

7- jk"Vªh;rk@Nationality………………………………………………………………………
8- tUe LFkku% ¼Place of Birth-Sub) ………………………………………………………………………
tUefrfFk ¼avd
a ksa es½a @Date of Birth fnukad@Date ekg@Month o"kZ@Year

9- vkosnd e0iz0 dk ewy fuoklh gS ¼gkW@ugha ) Are you a resident of Madhya Pradesh (Yes/No)
ewy fuoklh izek.k i= dh Nk;kizfr vo’; layXu djsa @Attach the photo copy of Domicile Certificate)
10- D;k v/;;u esa varjky jgk% gkW@ugh % In case there is any gap in study -----------¼’kiFk i= layXu djs½a
11- foxr mÙkh.kZ ijh{kk dk fooj.k % ¼lEiw.kZ tkudkjh Hkjs½a Particulars of last qualifying exam. (Supply
Information)

mÙkh.kZ d{kk vuqdez kad ukekadu o"kZ Js.kh izkIrkad@iw.kkZd


a fu;fer Regular/ fo"k; cksM@
Z fo-fo-
Exam Passed Roll No. En. No. Year Divi Marks Obtained Lok/;k;h Private Subject Board/ Unv

10oh-

12oha

II
UG
III

Previous
PG
Final
izos'k& lfefr dh vuq’kalk ¼RECOMMENDATION OF THE ADMISSION COMMITTEE)
1- vkosnd dks d{kk-----------------------------------------------------------------------esa fuEufyf[kr fo"k;ksa ds lkFk vLFkk;h izo’s k fn;k tkrk gS &
The applicant is provisionally admitted to class…………………with following subject.
(1)…………………………(2)…………………………(3)………………(4)……………………
2- vkosnu vLohd`r fd;k tkrk gS dkj.k--------------------------------------------------------------------------------------------------------------------------------------------------------
Application not accepted due to…………………………………………………………………
3- fuEu dfe;ksa dh iwfrZ mijkar izo’s k dh vuq’kalk dh tkrh gS--------------------------------------------------------------------------------------------------------------
Admission is recommended after fulfilling the required information/ documents………………..
……………………………………………………………………………………………………

izkpk;Z@Principal izo’s k lfefr ds la;kstd@lnL; ds gLrk{kj] uke o fnukad


Signature and name of the Convenor/member of the Admission Committee with date
------------------------------------------------------------------------------------------------------------------------------------

dk;kZy;hu mi;ksx gsrq (FOR OFFICE USE ONLY)


izo's k jlhn dzekad------------------------------------------------jkf’k------------------------------------------------------------fnukad--------------------------------------------------------izkIr gq;sA
Admission fee receipt No……………………Amount…………………Date……………….Received.
……………………………………………………………………………………………………………

fnukad % izkIrdrkZ ds gLrk{kj


Date : Signature of the Recipient
------------------------------------------------------------------------------------------------------------------------------------
Ikkorh (Receipt)
Jh@dqekjh@Jherh-------------------------------------------------------------------vkRet@vkRetk Jh@Jherh------------------------------------------------------------------------------------------------------
dk izo’s k vkosnu QkeZ d{kk --------------------------------------------------------------esa izo’s k gsrq fuEukafdr izek.k i=ksa dh Nk;kizfr;ksa ds lkFk fnukad--------------------
--------------------------------------------- dks tek fd;kA
submitted the application for admission for class……………………with the photo copies of the following
documents:
.
(1) gkbZ Ldwy ¼10oh½ dh vadlwph dh Nk;kizfr@Photocopy of the Highschool (10th ) mark sheet
(2) gk;j lsd.s Mjh ¼12oha½ dh valwph dh Nk;kizfr@ Photocopy of the Higher secondary (12th ) mark sheet
(3) Lukrd & izFke] f}rh; ,oa r`rh; dh vadlwph dh Nk;kizfr@ Photocopy of the UG I, II, III mark sheet
(4) LukrdksÙkj iwokZ) ,oa mRrk)Z dh vadlwph dh Nk;kizfr@ Photocopy of the P.G. Pre & Final marksheet
(5) vkjf{kr laoxZ dk izek.k i=@Certificate for reserved category
(6) vk; izek.k i=@Certificate for Income
(7) v/;;u varjky ¼xSi½ dk 'kiFk i=@Certificate for gap in study
(8) vU; izek.k i=@Other documents
Signature of the Recipient

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