Reg. No. :.................................

Swami Vivekanand University

N.H. 26. Narsingpur Road, Sironja, SAGAR (M.P.) 470228
SAGAR

ADMISSION FORM

Session :.................................

Courses :
Counselor Name :

Counselor Code:

Students Name:
Fathers Name

Photo to be attested by Gazetted Office

Mothers Name

Guardians Name

Date of Birth
DD MM

YYYY

Medium

English

Hindi

Caste (Photocopy of Certificate )

To be attached

GEN

SC
Name of State
(b) District

ST

OBC

Domicile of:

M.P.

Other State

Place of Birth : (a) Village /City :

( c ) State
Mothers Mothers

Occupation :Fathers/Husbands :

Yearly Income of Fathers/Husbands:

Permanent Address :

District :
Phone No. (with STD Code)

State
Mob. No.

Pin Code :

E-mail Address

Students Local Address :

District :
Phone No. (with STD Code):

State:
Mob. No :

Pin Code :

Guardians Address :

District :
Phone No. (with STD Code):

State:
Mob. No :

Pin Code :

Duration of fathers /Husbands /Guardians Stay in MP-Years

Details of Entrance Exam Conducted by the Govt./Univesity Name of Exam Roll No. Max. Marks Mark Obtained Percentage Merit Rank

Details of the Educational Progress of the Applicant Exam 1

High School Higher Sec Graduation Post Graduation B.Ed.(For M.Ed)

Year 2

Educational Institute 3

Name of Board / University 4

Marks Obt/ %age Division Max.Marks 5 6 7

Subject 8

Optional Subjects for Applied Course (If Applicable):

1 3 2 4

(Note : Incase of Incomplete details the form might be rejected.)

I hereby declare that the information given by me in this form and the certificates attached here with are true to the best of my knowledge and Belief.

Students Signature

Fathers/Guardians Signature