SPS JANTA COLLEGE
(Affiliated to Kurukshetra University, Kurukshetra)
A M I N O R I T Y I N S T I T U T I O N
SARASWATI NAGAR (YAMUNA NAGAR)
Session 20 – 20
APPLICATION FORM FOR ADMISSION IN
Class …………… Roll No. …………………………… University Registration No. ………………………………….

1 Name in full (Block Letters) ……………………………………………………………………………………………………………………….
Name in Hindi ………………………………………………………………………………………………………………………………………….
(Name should correspond with that given in the Matric or Higher Secondary Certificate)
2. Date of Birth (as given in Matric Certificate)……………………………………………………………………………………………………………………………………………………..
(in words ………………………………………………………………………………………………………………………………………………………………………………………..)
3. (a) Father’s Name :………………………………………………………………………………………………………. Occupation ………………………………………………
(b) Annual Income :……………………………………………………………………………………………………………………………………………………………………….
4. (a) Mother’s Name Smt. :……………………………………………………………………………………………….. Occupation ……………………………………………..
(b) Annual Income :………………………………………………………………………………………………………………………………………………………………………..
5. Correspondence Address ………………………………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………………………………………………………………………
Phone No. ………………………………………………………………………. E-mail ID ………………………………………………………………………………………………..
6. Permanent Address ………………………………………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………………………………………………………………………
Phone No. ………………………………………………………………………. E-mail ID ……………………………………………………………………………………………….. 7. Category General/BC/SC/ST/BPL/Handicaped/Ex-Serviceman (Attach Proof) ………………………………………………………………………………………….
8. Nationality ……………………………………………………. Religion ……………………………………………………. Caste …………………………………………………….
9. (a) Do you require Haryana Roadways Bus Pass / College Bus to attend the college …………………………………………………………………………….. (b) If so, from which place ……………………………………………………………………………………………………………………………………………………………
10. (a) Did you pass your qualifying exam from a Board/University other than Haryana Board/K.U.K. ?
(b) If so name it ………………………………………………………………………………………………………………………………………………………………………….
(Attach Migration certificate and lower class exam certificate in original along with two Photo copies)
11. Voter ID No. 12. Aadhar Card No.
13. Email ID Contact No. Blood Group
14. Subject offered
Compulsory Subjects Subjects (please consult prospectus)
(i) English 1. …………………………………………………………..
(ii) Hindi 2. …………………………………………………………..
(iii) Environment Studies 3. …………………………………………………………..
(Qualifying Subject) 4. …………………………………………………………..
5. …………………………………………………………..
6. …………………………………………………………..
15. Details of previous examinations passed :

Name of Class Name of Board / University Name of the institution Month Year of Passing Exam Roll No. Marks %of Marks Subjects Taken
Obtained Total
Matric
10+2
B.A./B.Com/BBA/B.Sc.-I
B.A./B.Com/BBA/B.Sc.-II
16. Special Merit won in the institution last attended in …………………………………….. Nature of the Merit ……………………………………………………….
Studies / Sport / Debates/ N.S.S. Cultural activities. ………………………………….. College / University …………………………………………………….. 17. Do you want to take up NSS / Sports ……………………………………………………………………………………………………………………………………………………
(Mention your choice)
(P.T.O.)

THE COLLEGE RESERVES THE RIGHT TO REFUSE ADMISSION TO ANY STUDENT DECLARATION BY THE APPLICANT

1. I declare that I am applying for admission at the explicit wish of my parents / guardian and promise not to take part in any political activity of any kind of any agitation whatsoever directly or indirectly and undertake to abide by the rules framed by the Principal from time to time. In case of my being admitted to this College I HOLD MYSELF RESPONSIBLE for any delay or failure to make any such payment or a result of the particulars given here in proving incorrect.
2. I solemnly declare that I have not so far been admitted to any other affiliated College in the class to which I am seeking admission to your College and submit herein my last Board / University Examination Certificate in original for verification.
3. I agree to abide by rules and regulations given in the College prospectus or framed by the College authorities from time to time. My parents / guardian will be responsible for payment of College dues / arrears.
4. Security not withdrawn within one year of leaving College will lapse.

5. Before leaving the College, I am required to settle outstanding dues failing to do so I will have to pay College dues for the entire session.

6. “I solemnly declare that the information detailed by me in the Admission Form is true and correct to the best of my knowledge and belief and nothing has been concealed therein. I also undertake to abide by all the rules, regulations and instructions of the College and also of the University. I am taking admission in the College provisionally at my own risk and responsibility subject to confirmation of my admission by the College / University. If, at any stage, I have been declared ineligible and my admission is cancelled by the University ab-initio, I will abide by the orders of the University and forego every right or claim to it.
RAGGING :

Ragging in educational institutions is banned and any one indulging in ragging is likely to be punished appropriately, which may include expulsion from the institution, suspension from the institution or classes for a limited period or fine with a public apology. The punishment may also take the shape of (i) withholding scholarships or other benefits, (ii) debarring from representation in events, (iii) withholding results, (iv) suspension or expulsion from hostel or mess, and the like. If the individuals committing or abetting ragging are not/cannot be identified, collective punishment can be awarded to act as a deterrent.
The following will be termed as the act of ragging : any disorderly conduct whether by words spoken or written or by an act, which has the effect of teasing, treating or handling with rudeness any other student(s), indulging in rowdy or indisciplined activities which causes or is likely to cause annoyance, hardship or psychological harm or to raise fear or apprehension there of in fresher of junior student(s) or asking the student(s) to do any act or perform something, which such student(s) will not do in the ordinary course and which has the effect of causing or generating a sense of shame or embarrassment so as to adversely affect the physique or psyche of a fresher or a junior student.
Candidate are required to submit the following two affidavit to ensure that they shall not be indulge in ragging (above type of activities)

• Affidavit by the Student (available at annexure – I)
• Affidavit by Parents / Guardian (available at annexure – II)

UNDERTAKING BY THE STUDENT WHO HAS PASSED HER/HIS LOWER EXAM. FROM OTHER BOARD / UNIVERSITY
I shall submit my original migration certificate for the qualifying examination on the basis of which I am seeking admission to the above course along with mark- sheets within 15 days from the date of my admission in the College for the verification of the eligibility. If, the certificate is not submitted within this period or I am found ineligible for admission at stage, I my self shall be responsible for the consequences.

Dated :

DECLARATION BY THE FATHER / GUARDIAN

Signature of Applicant

I undertake the responsibility of paying all the dues in respect of my daughter / son and hold myself responsible for her good conduct and shall accept the Principal’s orders as final and binding in all respects.

Documents Attached :
1. Photocopy of DMC of lower class (2 sets) 2. Photocopy of caste certificate (2 sets)
3. Two passport size photographs 4. Photocopy of proof of date of Birth (2 sets)
5. Photocopy of Ration Card / Aadhar Card 6. Gap year affidavit (wherever applicable)
7. Migration Certificate in original (wherever applicable)

Recommendations of Admission Committee
Recommended for Admission after checking of eligibility.

Signature :

1. 2.
(Member)

3.
(Member)

For Office use only

Admit provisionally.
(Member)
Principal

Receipt No.

Amount Rs.

Date:
Signature of Fee Clerk