Application No.

Admission Cell
Shobhit University
NH-58, Modipuram, Meerut 250 110, UP, India
Tel: 0121 - 2575091, 2575092
Fax: 0121-2575724
Email: [email protected]
Website: www.shobhituniversity.ac.in
Estd. u/s 3 of UGC Act 1956
SMS SU to 53030

APPLICATION FORM FOR ADMISSION 2013-14

INSTRUCTIONS (for Office Use Only)
R Form should be filled in Block Capital Letter in English Language with Blue Ink only.
R If you have any questions about your eligibility for a particular program, please Registration No.
contact the Admission Cell before filling up the form.
R Filling up of Application Form does not guarantee an admission. Student File No.

1.

Branch Preference
PROGRAM APPLYING FOR
2.
Program name
3. Paste Recent
Passport size
4.
coloured
5.
Photograph
ADMISSION CRITERIA
(upload for online
Marks in Qualifying Exam GD/PI/Test Conducted by SU submission)

Test Conducted at National/ State level by Govt./other organisation prescribed by SU

Details of Test: (if applicable)

Test Name Conducting organisation Roll No./ID/ Date of Test Score/ Validity of
Registration No test taken Rank Score/Rank
1.

2.

PERSONAL INFORMATION
Name of the applicant (exactly as it appears on academic High School transcript/certificate of qualifying examination)

Mother’s Name

Father’s Name

Legal Guardian’s Name

Relation

Date of Birth Gender Category Physically Nationality

DD MM YYYY Male General ST Minority Handicapped Indian Others
SC OBC (Non creamy Layer) Yes
If other, specify
Female No
If other, specify
(for abbreviations, refer Part-B)

Signature of the Applicant Signature of the Parent/Legal Guardian

01
 CONTACT DETAILS
CORRESPONDENCE ADDRESS (for all communication by the University)
Line 1
Line 2 City/Town
Distt. State/Province Country
Post Office Police Station Zip/ Postal Code

PERMANENT ADDRESS (IF DIFFERENT) LOCAL GUARDIAN ADDRESS (IF ANY)

Line 1 Line 1

Line 2 Line 2

City/Town Distt. City/Town Distt.

State/Province Country State/Province Country

Zip/Postal Code Post Office Zip/Postal Code Post Office

Police Station Police Station

Country Code STD Code Telephone No. Home Town
Rural
Mobile No. (Applicant) Mobile No. (Parent/Guardian) Urban (Town)

Urban (Metropolitan)
E-mail address (Applicant) E-mail address (Parent/Guardian)

QUALIFYING EXAM :
ACADEMIC INFORMATION
10+2 (12th) 3 yrs. Diploma after 10th Graduation Post Graduation

DETAILS OF 10th/ O Level

Year of passing Board Stream Medium of Examination Total Marks Marks Obtained % of Marks/CGPA

DETAILS OF (10+2) 12th/ A Level

Year of passing Board Stream Medium of Examination Total Marks Marks Obtained % of Marks/CGPA

DETAILS OF DIPLOMA
Year of passing Board/University Programme Name Medium of Examination Total Marks Marks Obtained % of Marks/CGPA

DETAILS OF GRADUATION
Year of passing University Programme Name Medium of Examination Total Marks Marks Obtained % of Marks/CGPA

DETAILS OF POST GRADUATION

Year of passing University Programme Name Medium of Examination Total Marks Marks Obtained % of Marks/CGPA

DETAILS OF OTHER QUALIFYING EXAM

Year of passing University Programme Name Medium of Examination Total Marks Marks Obtained % of Marks/CGPA

Signature of the Applicant Signature of the Parent/Legal Guardian

02
 WORK EXPERIENCE (If any)
Total Work Experience (in years) : Years Months

FOR INTERNATIONAL APPLICANTS ONLY

(including PIO, OCI and Foreign Nationals)
Information as in Passport
Surname
Given Name
First name Middle name

Nationality Birth date Country of birth

dd/mm/yyyy
Passport No. Place of Issue Date of Issue Date of Expiry
dd/mm/yyyy dd/mm/yyyy

English Proficiency Test taken (Compulsory for International applicants whose medium of study has not been English)
Sr. Test Date of test taken Test Scores
1.
2.
3.

HOSTEL FACILITY
HOSTEL FACILITY REQUIRED Yes No

(for Office use only)

Hostel allotted Room No. Signature of dealing official with date Unique ID

OTHER INFORMATION
PARENT’S INCOME (p.a.) (`)
(This information is required for data base purposes only and will not have any impact on admission process)

Below 1,00,000 1,00,001 to 5,00,000 5,00,001 to 10,00,000 10,00,001 to 25,00,000 Above 25,00,000

DISCIPLINARY HISTORY
Have you ever been subjected to disciplinary action by any school, college or university attended, or convicted of any criminal case or
otherwise of a violation of any law?

Yes No

If yes, briefly specify the details

Signature of the Applicant Signature of the Parent/Legal Guardian

03
 PAYMENT DETAILS

Tick ( ) if University
DESCRIPTION Tuition Fee Hostel Fee Caution Money
applicable Charges

Amount Paid

By Cash
Cash Receipt No.

By Demand Draft
DD No. :

Bank :

Date :

Through Online :
Online Transaction No. :

Receipt No.

Balance Amount

Signature of dealing official Unique ID : Date :

CHECKLIST
Tick ( ) Tick ( )
Sr. Description if Sr. Description if
Submitted Submitted
Essential documents to be submitted by all applicants Additional documents to be submitted by the applicants, if applicable
1. Copy of 10th / ‘O’ level or equivalent certificate 1. Entrance Test Rank/Score Card
bearing testimony to D.O.B .
2. Copy of Mark sheet of qualifying Examination 2. Applicants for claiming reservation are required to
submit attested photocopy of domicile and
reservation certificate (as applicable)
3. One recent passport size colored photograph, if not 3. In case of gap in education, Notarized Affidavit
pasted/uploaded (as applicable) to be submitted
4. Proof of residence (Passport/Voter Identity 4. Copy of passport to be submitted by International
Card/Ration Card/Driving License/ Electricity Applicant, if applicable
Bill/Telephone Bill/Bank Account Statement)
5. School Leaving Certificate /Transfer Certificate/ 5. Other, if any, specify_______________________
Migration Certificate/Character Certificate
6. DD/PO/Receipt etc. pertaining to Payment(s)

DECLARATION BY THE APPLICANT

I,………………………….………….…………………………………………………………, S/D/o Shri ………………………………………………………………………….………….……
R/o……………………………………………………………………………………………………………………………………………………………..……………………………………………. ,
seeking admission to …………………………………………… programme at Shobhit University, Meerut, hereby declare that all the particulars given above
are true, complete and correct to the best of my knowledge and belief. I have never been convicted by any court of law or disqualified by any Board/
University. My candidature/admission may be cancelled and appropriate action be taken against me at any stage, if any information furnished by
me is found to be incorrect or misleading. I am aware of University approach toward ragging and the punishment to which I am liable if found guilty of
ragging. Disputes, if any, are subject to Meerut jurisdiction only. All applications on the prescribed Application Form shall be sent along with a
demand draft of non-refundable processing charge, in favour of Shobhit University payable at Meerut to Admission Cell.

Signature of the Applicant Signature of the Parent/Legal Guardian

04