IAWAHARLAL NEHRU UNIVERSITY Last Date: 75th Dec, 2O22

OFFICE-OF THE DEAN OF STUDENTS

FORM NO. IHA - 1OO

APPLICATION FOR ALLOTMENT OF SJNGLE SEATqR R9OM

l. Name of the
2.Gender: Male I-l FemaleE 3. WhetherbelongstoPwD. Yes t] (AttachProor) No tl
4. Registration No. (As per registration folio)
5. School & Center
D/D M/M YYYY
6. Date of Birth: D/D M/M YYYY
il
7 . Date of admission
i) M. Phil./Ph.D integrated il

a) Date of M.Phil Viva-Voce/Promotion to Ph'D. (copy of order)

b) Date of Ph.D confirmatioh (copy of order)

ii) Date of Admission in Direct Ph.D. (copy of order/letter of Admission Branch)

8. TotalNumber of semesters complete (including Monsoon 2022) in the said Prog. of study.
lf any break due to Zero semesters, field work or any other reason (Attach copy of the relevant) order) [T-l
9'WhetheravailingJRF/SRForanyfellowship,ifyes,detailswithamount.-,HRA(ifany)

Funding agency .(attach copy)

10. Details of Hostel:
S. No Name of Hostel Room No. From To
(DD/MM/YY) (DD/MM/YY)
I
)
* Note l. Please Attach copy of IHA form l. (HostelAllotment form)
* Note 2. Please attach Hostelvacation form along with form 1, if hostelwas changed.

I l. Total No. of semester's Double Seater hostel resident (Upto Monsoon 2022) t-T_l
12. Choice of Hostel Area (Please mark uny on.EI;' E Brahmaputru l-lOtt .r than Brahmaputra
DECLARATION
I hereby declare that the information given above is true to the best of my knowledge and belief and that nothing has
been concealed. I understand that I have to vacate the hostel and wait for my turn without hostel if submit any false
information.
Date Mobile/Contact No. Signature of applicant
EI
Ensure required document to be enclosed mark
I. Copy of Registration folio (Current) tl
2. Office order of M. Phil viva -Voce/promotion to Ph.D. confirmation Letter
3. Copy of Direct Ph.D. admission order/Letter E
4. Copy of Zero Semester/Year, Field Work etc., if availed. E
5. Copies of the IHA Form No. I (available in your hostel file) tr
6. Copy of office order/proof for change of Hostel.
7. Copy of fellowship order (JRF/SRF etc.) E
---------For Administration/School/Centre Use - For Hostel Use-----------
Verified from the record that the information given Verified from the record that the information
In Column No. I to 9 is correct. Given in Column No. l0 to I I is correct.

Signature ofoffice In charge