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Attach one recently
taken passport size
photograph duly
Application for Admission to ________________________________Seesion : 200 - 200
(Write the nane of the Institute)
[ Please tick ( ) in the appropriate place and strike out which is not applicable ]
1. Admission sought for
a) Programme of study :
b) Major Subject :
c) Subsidiary or other Subject (s), if any :
2. Name in Full (In BLOCK LETTERS) :
3. Sex : Male Female 4. Nationality :
4. a) Whether a person of Indian Origin Yes No
b) Whether Non-Resident Indian Yes No
c) Mother Tongue
5. a) Date of Birth : Day Month Year
b) Place of Birth :
6. Hostel Accommodation : Necessary Not necessary
7. Address
For correspondence Permanent Father/Mother/ Aperson’s address
Address Spouse/ who can be
Guardian’s contacted in case
address of emergency
Post Office
Postal Code
Telephone No. (i)
Cellphone No. (ii)
Fax No.
9. Language Known Can Speak Can Read Can Write
Serial No......................................
D.D. /Cash Coupon No ..............
DATE : .......................................
P. T. O.
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10. a) Present Occupation :
b) Designation, if employed :
c) Annual Income (in U.S. Dollar) :
d) Name, contact address, telephone, fax & e-mail of employer :
11. In case, Financially supported from any organization / Individual :
a) Name of the Organization / Institute :
b) Address :
12. Passport No. : Date of Issue :
Place of issue : Valid till :
13. Visa : Type No.
Place of issue : Date of Issue :
14. Details of the Course (s) of studies taken by the candidate earlier or currently taken in Visva-Bharati :
Year Course of Department Institute / Registration Year Result
of Study Bhavana No. (Division /
Study Class)
15. Whether the applicant is prepared to take an entrance test at Visva-Bharati : Yes No
16. Purpose of Study :
17. Special interest, if any :
18. Institutions where you have studied since Secondary level education :
Level / Course of Study Year Name of the Address Telephone No. /
of School /College Fax No./e-mail
passing Institue etc.
(a) (b) (c) (d) (e)
P. T. O.
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19. Referee Particulars :
Name Designation Contact Address Telephone No.
Referee 1
Referee 2
Referee 3
20. Only for Fine Arts/ Performing Arts discipline :
Details of the attached photography/ CD/ Cassettes, etc. of works.
21, Only for Research programme (Ph.D/D.Litt./ :
(A) Broad field of proposed Research Work:
(A synopsis of the proposed work is
to be attached)
(B) Tentative Title of the proposed thesis :
(to be given in the language in which
the thesis will be prepared as well as
its English translation )
(C) Named of Supervisor(s) :
(If the candidate has any choice)
(D) (i) Research/Field experience, if any :
(E) Permission from Government :
Permission Letter No. :
Issued by :
Declaration :
1. The statements made above are tfrue to my knowledge and belief. In case any entry or information or document (s)
is /are found to be false/fake, this shall entail automatic cancellation of my admission besides rendering me lible to
such action as the university may deem proper.
2. If selected,
(a) I shall abide by the rules and regulations of Visva-Bharati and take part in the traditional functions and festivals
of Visvs-Bharati
(b) I shall not engage in (i) political activities, (ii) activities prejudicial to the interest of th eUniversity as well as
to India (iii) activities which could be embarrassing to the relations between India and any foreign country.
(c) I shall abide by the rules of discipline and proper conduct which may be applicable.
(d) I shall not leave the Headquarters without prior permission of the concerned University authority.
Signature of the Applicant
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CHECK LIST for the Applicant :
Please put ‘ ’ (tick) marks.
(1) Whether entered All relevant particulars in the Applicant From YES NO
(i) Passport-size photograph duly attested YES NO
(ii) Educational Documents attached (put ‘ü’ (tick marks) :
Level of Photocopies of Academic Equivalence Remarks
Examination Marksheets & Transcripts Certificate
Whether Whether Whether
Attested Attested Attested
Secondary (10 Yrs.)
or Level or
High er Secondary /
Senior School Leaving
Certificate or equivalent
(10+2 Yr.)
Bachelor’s Degree/
Graduation or
(B.A., B.Sc., B.F.A.,
B.Mus. etc.)
Master’s Degree
or equivalent
(M.A., M.F.A.,
M.Mus. etc.)
Any other degree/
(3) Medical/Health Certificate attached : YES NO
(4) Birth Certificate attached : YES NO
(5) Two Referee’s Certificates attached : YES NO
(6) No Objection Certificate/School or College Leaving Certificate YES NO
(if already studying in an Indian Institute) attached :
(7) Additional attachments :
(A) For Fine Arts Courses only
At least 6 colour photographs attached YES NO
Whether attested YES NO
(B) For Performing Arts Courses only
Audio-visual/Audio CDs/Cassettes attached YES NO
Whether attested YES NO
(C) For Research/Ph.D./D.Sc./D.Litt. only
A short synopsis of the topic indicating
(i) the field of Research YES NO
(ii) Tentative title of the thesis YES NO
‘‘No Objection Certificate’’ from the employer, if the YES NO
applicant is in employment :
Price Rs. 400.00 / 10 U.S. Dollar only.