APPLICATION FORM FOR HOSTEL ADMISSION

(This form, together with the declaration, medical fitness certificate and proof of medical insurance,
must be submitted electronically to the Hostel Office by email.)

I, , am studying in ICT Mumbai for the

program. I belong to the Department
and work under the guidance of . I am an M. Tech. / M.E. /
M. Chem. Engg. / M. Pharm. research scholar (2020-2022 batch) in the third semester. I wish to apply
for admission to the hostel from to . I am willing to pay hostel
fees for the entire academic year (2021-22). I have permission from my Research Supervisor to begin
my research work in the laboratory. I am aware that limited hostel seats are currently available. I will
stay only for the period specified by the Warden / Hostel Office. I agree to these points stated below:

1. During admission, I shall not bring along with me any accompanying person inside the hostel. If
it is found that I have high fever, I may be denied entry. Upon admission, I will stay alone inside
a room for a period specified by the hostel office/Warden. I will compulsorily practise self-isolation
and not leave the hostel premises during this period.
2. After the completion of my isolation period, I will agree if the Hostel office temporarily shifts me
to another room (if necessary) for accommodating newer students (who, in turn, will now undergo
compulsory isolation). I will commence lab-work only after my isolation period is over.
3. I will always use mask and sanitizer; ensure social distancing; and practise cleanliness and hygiene.
If I develop any symptoms such as fever, dry cough, runny nose, sore throat, shortness of breath,
or loss of taste and smell, I will immediately report to the Warden / Hostel Office and seek medical
opinion from the hostel doctor.
4. I am aware that Warden / Hostel Office reserves the right to rearrange my hostel-number, room-
type, duration of stay in hostel, in-time (or reporting time in hostel at night) and number of students
per room to meet COVID-19 related safety requirements.
5. I am aware that joining the hostel mess facility is compulsory. I will pay mess bill accordingly.
6. I am aware that common areas such as playgrounds, courtyards, pavilion, gymnasium, indoor
sports room, TV room, reading room and study room will be closed till further notice.
7. I am aware that social gatherings / hostel fests / hostel sports / other hostel-related events will not
be permitted until further notice.
8. I am aware that Warden / Hostel Office reserves the right to deny / permit entry of staff, vendors,
visitors and guests inside hostel and mess premises.
9. I am aware that I may be permitted to go outside the campus only after completion of the self-
isolation period.
10. I am aware that the availability of guest rooms is subjected to the pandemic scenario.
11. I shall avoid crowding inside the mess, hostel and campus.
12. In the unfortunate case of a COVID-positive patient inside the hostel, I will follow necessary
instructions issued by the Warden / Hostel Office.
13. I am aware that defaulters will face appropriate disciplinary action.

Signature: Date:
Name: Mobile:
Emergency Contact Numbers: