CENTRAL UNIVERSITY OF HARYANA

(Established vide Act 25 (2009) of Parliament)

VILLAGES (JANT-PALI), MAHENDERGARH, HARYANA
Temporary Camp Office: Govt. B.Ed. College Building, Narnaul (Distt. Mahendergarh) Haryana-123001

TEL: 01282-255002, 255003;

Website: www.cuharyana.org

APPLICATION FORM FOR MASTERS/ RESEARCH
PROGRAMMES
Academic Session 2012-13
Application Form No.
(For Office Use Only

Paste Here One
Recent Passport
Size Color
Photograph
(DO NOT
STAPLE)

Programme Applied for:
Programme
Subject
Fee Details
Name of Bank

D.D. No. &Date

Amount

NOTES:
1. Read the information available on website carefully before filling application form.
2. Please fill all the columns legibly in block letters. The candidate shall be responsible for all entries.
No documents (Copies of certificates, mark sheets etc.) is required to be attached. Before filling
application form, the candidates are advised to ensure their eligibility for the programme applied for
in accordance with the eligibility conditions for the various programmes available on website. It will
be the sole responsibility of the candidate to make sure that he/she fulfils all the conditions
prescribed for admission. The decision of the University shall be final.
2. Incomplete or unsigned applications shall be rejected summarily.
Name (in CAPITAL letters)

..………………………………………………………………………………………………………

Father’s Name

...………………………………………………………………………………………………………

Mother’s Name

...……………………………………………………………………………………………………….

Sex

………………………………………………………….

Date of Birth

……………………………..…………………………………….

Address for Correspondence ……………………………………………………..............................................
…………………………………………………….............................................................................................
Phone……………………………………… Cell ….………………… E-Mail…………………………………………………
Category (SC / ST / OBC / PH / Others) …………………………………………………………………………………………….

Yes or No... Yes or No State if there was any gap in your studies. Year………... Subject:……………………… Year & Date of Examination…………………… If holding the Fellowship.. if any ……………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………... Any Other Examination a) Give details of publications & research work carried out. Present or previous employment... If yes....D... Give period...………………………………………………..... admission) Write... reasons etc.....………………………………………………. degree? (for those applying for Ph.......: ……………………………………………………………………………………………………... Roll No…………………………………............Academic Qualifications Examination Passed Board/ University Year of Passing Max Marks Marks Obtained % of Marks & Division Subjects Studied and Passed Matric Inter/ SSC/ 10+2 Graduation .. c) Do you possess M......... ……………………………………………………………………………………………………………………………………………… b) Have you qualified in the UGC National level test for JRF/NET/SLET? Write.. give the following details: Name of the Exam……………………………………………. if any Organization & Address Position Held Duration/ Period Nature of Duties ...Phil. ……………………………………………………………………………………………………...... Post-Graduation . the date from which it is held: Date…………… Month………….....

I have not concealed any information. besides rendering me liable to such action as the University may deem fit..……………………… . I hereby declare that the information given above is true....Phil/Ph.Any other relevant information: ………..…………………………………………………………………………………………………......... …………………………………………………………………………….... / Cell ……………………………………………………….. …………………………………………………………………… …………………………………………………….……………………………… ……….…………………………………… …..... if granted.. (For M. cancellation of the degree if awarded. PIN ………………………………………………………………….. Email: …………………………………………………………………. Students only) Mention areas of research interests in order of preference: 1) ………………………………………………………………………………………………………………………. 3) ……………………………………………………………………………………………………………………….. / Cell …………………………………………………… Email: ……………………………………………………………… UNDERTAKING BY THE APPLICANT I solemnly affirm that the information furnished above is true and correct in all respects. In the event of any medical or other emergency.D....……………………………………………………………………………………………………....…………………………………………………………………………………….. Tel No...………………………………………………………….………………….……………………. …………………………………………………………………… …………………………………………………………………... this shall entail automatic cancellation of my admission.. I hereby undertake to pay the fees and other charges as prescribed from time to and will abide with the rules and regulations in force as amended by the University from time to time. In case any information in this application is found to be false or incorrect at any time (during or after completion of the course).……………………………… 2) ………………………………………………………………………………………………………………………... my parent/s or Guardian may be contacted at the address given below: Place: Date: Signature of the Candidate Name and address of local guardian (if any)…………………………………………………………………………………… .…………………………………………………………………………………………………….…………………………………………… ………………………………………………………... Place: Signature of Candidate Date: PRESENT RESIDENTIAL ADDRESS MAILING ADDRESS ………………………………………………………………………... ……………………………………………………………………………..... PIN ……………………………………………………………………… Tel No.. ……………………………………………………………………………....

. …………………………………………………………………………………………………………………..………………………………………………………………………………………… …………………………………………………………………….………………………………………………………………………………………………………………………………………………… ……………..……………………………………………………………………………………………………………………… ..……………………… ……………………………………………………………………………………………………………………………………….………………………………… …………………………………………………………………………………………………………………....……………………………………………………………………………………………………… ……………………………………………………….……………………………………………………………………………………………………………… ………………………………………………....………………………… …………………………………………………………………………………………………………………………………….Phil and not exceeding 500 words for Ph.… ……………………………………………………………………………………………………………………………………………………… …….PROPOSED AREA OF RESEARCH (Not exceeding 300 words for M.……………………………………………………………………………………………………………………………………………… ……………….…………… ………………………………………………………………………………………………………………………………………………….. IT IS NECESSARY AS IT WILL FORM BASIS OF INTERVIEW)..…………………………………………………………………………………………………………………………………… ………………………….………………………………… …………………………………………………………………………………………………………………..………………………………………………………………………………………………………………………… ……………………………………..………………………………………………………… ……………………………………………………………………………………………………..…………………………………………………………………………………………………… ………………………………………………………….……………………………………………………………………………………………………………………………………… ………………………..…………………………………………………………………………………………………………………………… ………………………………….……………… ………………………………………………………………………………………………………………………………………………..).…………………………………… …………………………………………………………………………………………………………………………..……………………………………………………………………………… ……………………………………………………………………………….……………………………………………………………………… ……………………………………………………………………………………….………………………………………………………………………………………………………………… ……………………………………………........……………………………………………… ………………………………………………………………………………………………………………..…… ……………………………………………………………………………………………………………………………………………………… ….…………………………………………………………………………………………… …………………………………………………………………. Attach separate sheet if necessary.………………………………… ……………………………………………………………………………………………………………………………..…………………………………………………………… …………………………….D..………………………………………………………………………………… ……………………………………………………………………………...…………………………………………………………………… ………………………………………………………………………………………….

.... Narnaul (Distt....... College Building................………………………………………………... Address for Correspondence…………………………………………………………………………………………………………… ………………………………………...... Sex ……………………………………Date of Birth .......………………………………… E-Mail……………………………… Proposed Area of Research………………………………………………………………………………………………………… (In case of Research Programmes only) Place: Date: Signature of the Candidate . Seal (To Be Filled in by Candidate) Programme Subject Name…………………………………………………………………………………………………………………........Ed.. (IN CAPITAL letters) Father’s Name…………………………………………………………………………………………………………………...CENTRAL UNIVERSITY OF HARYANA (Established vide Act 25 (2009) of Parliament) VILLAGES (JANT-PALI).... 255003.. HARYANA Temporary Camp Office: Govt........ MAHENDERGARH...... Mother’s Name…………………………………………………………………………………………………………………...org HALL TICKET FOR ENTRANCE EXAMINATION/ INTERVIEW Number (For Office Use Only) [TO BE SUBMITTED WITH APPLICATION FORM – OFFICE COPY] Paste Here One Recent Passport Size Color Photograph (DO NOT STAPLE) Signature of Issuing Authority ………………………………………………………………………. B...... Mahendergarh) Haryana-123001 TEL: 01282-255002.….................................. Website: www.... Phone……………………………………… Cell …....cuharyana.....

. Mother’s Name………………………………………………………………………………………………………………….. Phone……………………………………… Cell …............ College Building.... HARYANA Temporary Camp Office: Govt............................ Narnaul (Distt...... Mahendergarh) Haryana-123001 TEL: 01282-255002....... 255003... MAHENDERGARH.cuharyana...org HALL TICKET FOR ENTRANCE EXAMINATION/ INTERVIEW Number (For Office Use Only) [TO BE SUBMITTED WITH APPLICATION FORM – CANDIDATE’SCOPY] Paste Here One Recent Passport Size Color Photograph (DO NOT STAPLE) Signature of Issuing Authority ………………………………………………………………………......... Seal (To Be Filled in by Candidate) Programme Subject Name…………………………………………………………………………………………………………………...... Website: www........Ed..CENTRAL UNIVERSITY OF HARYANA (Established vide Act 25 (2009) of Parliament) VILLAGES (JANT-PALI).. Address for Correspondence…………………………………………………………………………………………………………… ……………………………………….....…......………………………………… E-Mail……………………………… Proposed Area of Research………………………………………………………………………………………………………… (In case of Research Programmes only) Place: Date: Signature of the Candidate ..... B. Sex ……………………………………Date of Birth ..……………………………………………….. (IN CAPITAL letters) Father’s Name…………………………………………………………………………………………………………………....................

5% 3% THE UNIVERSITY SHALL FOLLOW THE RESERVATION POLICY OF GOVERNMENT OF INDIA AND INSTRUCTIONS ISSUED FROM TIME TO TIME IN TOTO. 5% relaxation in marks to SC/ST candidates for deciding minimum eligibility conditions. CANDIDATESSHOULD SUBMIT RELEVANT CERTIFICATES IN ORIGINAL AT THE TIME OFADMISSION FOR AVAILING THE ABOVE RESERVATION. The reservation policy followed by the university for the current academic year is as follows: 1. . 2. Increase in intake capacity up to 5 % (KM) OTHER BACKWARD CLASS (OBC) SCHEDULED CASTES (SC) SCHEDULED TRIBES (ST) PHYSICALLY HANDICAPPED (PH) 27% 15% 7. 10% relaxation for Kashmiri migrants for deciding minimum eligibility conditions. 3.RESERVATION POLICY The University is governed by the reservation policies of the Government of India as issued and amended from time to time.

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