G H RAISONI UNIVERSITY,

SAIKHEDA (M.P.)
National Service Scheme
APPLICATION FORM FOR NSS VOLUNTEER

1. Aadhaar No.__________________
2. Name of the Student (In Capital) :____________________________________________________
Photograph of
3. Mother’s Name :_______________
NSS Volunteer
4. Occupation of Father :__________________________________________
Signature
5. Gender : Male/Female Date of Birth :___________________
6. Category : General/OBC/SC/ST Blood Group :___________________
7. Background : Urban/Rural
8. Course/Year of Admission :______________________________________
9. Department : ________________ Semester :______________________
10. Address : Permanent and Correspondence : Landmark_______________________________
City/Village_____________ Block(Tah) _________________ District_____________________
State __________________________Pincode________________
11. Email ID :________________________________ B. Mobile No :________________________
12. Year of Joining in NSS :__________________________________________________________
13. Extra curriculum :______________________________________________________________
14. Previous experience of NSS (yes/no) :_______________________________________________
15. Activities performed at college/school level: _________________________________________
16. Experience of Any Social Activity/work: ____________________________________________
17. Why do you want to join NSS unit as a Volunteer
_________________________________________________________________________________
_________________________________________________________________________________
[i] I, hereby declare to abide, adhere & promote the values of NSS.
[ii] I shall devote a minimum of 120 hours for various NSS activity.
[iii] I am physically and mentally fit and willingly join NSS unit as a volunteer.
Forwarded & Recommended.

(For Office Use Only)

Volunteer No. :

Signature of NSS Head Signature of NSS Coordinator

NSS Unit, G H Raisoni University, Saikheda, Tehsil. Saunsar, Dist. Chhindwara ( M. P) - 480337
Contact No. : +91 9111104291, 9595267878 Email: nss@ghru.edu.in, Web: www.ghru.edu.in