Year of NSS: 1st year

2nd year
Gokhale Education Society's
HPT ARTS & RYK SCIENCE COLLEGE, NASHIK - 422 005.

NATIONAL SERVICE SCHEME

ACADEMIC YEAR __________________ Paste
Passport size
ENROLLMENT PROFORMA OF NSS VOLUNTEER
Name of the University :____________________________________________________ photograph

Name of the College :____________________________________________________

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1. Name of the Student :_____________________________________________________________
2. Class :_____________________________________________________________
3. Roll No. :_____________________________________________________________
4. Date of Birth :_____________________________________________________________
5. Category -SC/ST/OBC/Gen:_____________________________________________________________
6. Present address with Tel.No.:____________________________________________________________
Mob. No.:_____________________________________________________________
7. Permanent address withTel.No.:__________________________________________________________
8. Email ID :_____________________________________________________________
9. Eligibility No. :_____________________________________________________________
10. Height (in cms) :_____________________________________________________________
11. Blood Group :_____________________________________________________________
12. Hobbies/Cultural talents :_____________________________________________________________
13. Parent occupation/profession:___________________________________________________________
14. Whether worked in NSS / NCC/:_________________________________________________________
any other social service earlier
(please Specify)
15. Why do you want to join NSS?:__________________________________________________________

Declaration of Student
I the undersigned hereby declare that, I will abide all rules & regulation laid down by Govt. of India
for NSS & will be binding on me to complete 240 Hrs. of work under NSS Regular Activities & one 10 days
residential NSS special camp during a tenure of two years during the volunteership.

Date:
Place:
(Signature of Student)

Permission of Parent/Guardian
I undersigned permit my son/daughter/ward to join NSS & will not object, he/she participating in 10
days residential NSS special camp & doing social service for the society.

Date:
Place:
(Signature of Parent/Guardian)