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15
 u Vku{oLkku Lk{qLkku

Agricultural Universities of Gujarat Common Admission - 2017

1. Applicant's Name (As per Bank Challan) :

2. Applicant's Full Name (As per Mark-sheet of Std. : XII) :

(Name should not be differed as appear in Bank Challan except spelling

mistake)

3.

Examination Board of Standard-XII :

Group :

4. Std. XII (HSSCE) Info

Std. XII (HSSCE) Seat No.:

Do you have English subject in Std. XII (HSSCE)?

Have you appeared in current year GUJCET (2017)?

[kw koLke GUJCET ykkue nkue sYhe Au.

5. Details of Examination :

Examination Year of Board Obtained Marks out

Passing of Total Marks
Obtained Out of
Marks Marks

16
6. Details of marks of Science subject and English obtained in Std.XII (HSSCE) :

Enter marks without grace (kuMk khLkk {kfoMk s kok)

Marks of XII. (HSSCE) Marks Total

obtained Makrs
Subject Theory Practical
(25% of Total Obt. Marks) (25% of Total Obt. Marks)

Marks Out of Marks Out of

1. Chemistry 100 50 150

2. Physics 100 50 150

3. Biology 100 50 150

Total 300 150 450

English 100

7. Applicant's Contact Details :

7.1 Correspondence Address :
Address :

Village/City :

Taluka :

District :

State :

Pincode :

17
7.2 Contact Info :
Phone with STD Code :

Mobile :

Email :
(Email & Mobile No will be used to send admission related details subject to Service
Provider and TRAI Terms & Condition)
8. Applicant's Personal Details :

Upload Photo :
BROWSE..... (Allowed formats jpeg, jpg, png) (Image size should be less than 2 MB)
Are you physically
Gender Challenged? Nationality
Select Select Select
Category (General/ SC/ST/ SEBC)
Select Category

Are you Domicile of Gujarat? Are you belong to Parsi Are you Ex-Service man/
kwshkkLkk hnukMke Aku ? Community? Defence Personnel?
Select Select Select

Date of Birth
9.
(a) Have you Participated at the International level Games / Competitions organized by
authorized organization of Sports Authority of India ?
Select
(b) Have you participated at the National level/Games Competitions organized by
authorized organization of Sports Authority of State ?
Select
(c) Have you participated at the National level/Games Competitions organized by
authorized organization of Sports Authority of District ?
Select
(d) Hostel accommodation required?
Select

18
 (e) Do you belong to farmer community?
Select
(f) Do you belong to fisherman community?
Select
(g) Have you passed Standard XII examination with Agriculture Subjects?
Select
u yukef[h rk {kfoex{kt kou nku, kku s YES ykuLk rMkufx fhku kkk ku rkLkk {kfoMkLke {kfoex nuk MkuLxh kh
y[qf hsw fhkLke hnuu

10.
ykuLkkELk Vku{o ko kk su ku nuk MkuLxh kh yMkh {kkkku Mkkku Vku{oLke hkE/[fkMke fhke VhSkk Au.
I have gone through the entire information Booklet for Degree Programmes along with all the terms
and conditions mentioned in it. I have clearly understood the provision of forfeiting of fees and
conditions of cancellation for the candidature of admission as mentioned in Information Booklet.
I hereby affirm that the information given/submitted by me through this online application is
complete and true to the best of my knowledge and that I have made this application with the consent
and approved of my parents/guardian. In the event of my being admitted to the consitituent college
of Universities. I undertake to abide by the disciplinary rules and regulations of the concerned
University. I also undertake to abide by the regulations regarding course curriculum and academic
standardss as may be prescribed by the University from time to time.

I Accept

khu k{u Vku{o Mkk{ex fhku khkk Vku{o{kt Mkwkhk (modify) fhk {kxu yufuLk ykEze yLku Mkeux fe k{khk {kukkE
Lktkh kh yLku E-{u ykEze kh yku.

Whenever you submit the form, the Application ID and Secret Key will be sent to your Mobile
Number & E-Mail ID for further Modification in your Form, if any.

SUBMIT Cancel

19
 krhr - y : rktk fuxukheLkk W{ukh {kxu {urzf MkxrVfuxLkku Lk{qLkku

Candidates Medical Certificate for Physically Handicapped Candidate

photo with FORM OF CERTIFICATE FOR PHYSICALLY DISABLED CANDIDATE FOR ADMISSION TO
round seal of FIRST YEAR COURSES IN AGRICULTURAL UNIVERSITIES OF GUJARAT STATE
Hospital AFTER 12TH (H.S.C) SCIENCE STREAM

1. Full Name of Candidate :

2. O.P.D. Case No. :

3. (a) Nature of disability :

(to be mentioned in the square on the right side)
POLIO; CEREBRAL PALSY,
HEMIPLEGIA, QUADRUPLEGIA,
AMPUTATIONS, PARAPLEGIA
CONGENITAL & AQUIRED DEFORMITY
VISUAL IMPAIRED,
HEARING IMPAIRED
OTHERS
(b) Any disability in upper limbs? Yes / No

(c) Extent of disability :

(to be mentioned in box on the right side)
BELOW 40% / 40% to 50% / 50% to 70%
/ ABOVE 70%
Note: A Candidate shall not be admitted to Graduate level courses of Agricultural Universities of Gujarat if
he/she suffers from the following disabilities, namely:
(a) Disability of total body including disability of chestorspine more than 50 %
(b) Disability of lower limb of more than 50%
(c) Disability of upper limb
(d) Visually handicapped candidates and those with hearing disability
(e) Candidates with progressive diseases like myopathies etc.
(f) Disabilities which otherwise would interfere in the performance of the duties in concerned course.
4. Despite the disability whether the candidate is fit to undergo Graduate YES / NO
level courses of Agricultural Universities of Gujarat
(Please state YES or NO in the square on the right side.)

I certify that Shri/Kum_____________________________________________________ has been examined by me

Dr._______________________ Designation:_____________________ on Dt. / /201 , and has been found physically
handicapped and in my opinion, he/she is in a position to undertake Graduate level courses of Agricultural
Universities of Gujarat.

Outward No.: Signature of Competent Authority of

Date : Govt. Hospital (District or State level)

STAMP
Round

seal Countersigned by Medical Superintendent /

Civil Surgeon of Govt. Hospital (District or State level)

20