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Utkal University, Bhubaneswar, Odisha P.G. Admission Form: Name of The Department

This document is a postgraduate admission form for Utkal University in Odisha, India. It requests information from applicants such as name, date of birth, gender, address, academic history, category and reservation details, and a list of required enclosures. The applicant must sign an undertaking declaring that the information provided is true and correct, and submit the form along with a demand draft for Rs. 600 to the head of the relevant department.

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Sourajit Pattanaik
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129 views2 pages

Utkal University, Bhubaneswar, Odisha P.G. Admission Form: Name of The Department

This document is a postgraduate admission form for Utkal University in Odisha, India. It requests information from applicants such as name, date of birth, gender, address, academic history, category and reservation details, and a list of required enclosures. The applicant must sign an undertaking declaring that the information provided is true and correct, and submit the form along with a demand draft for Rs. 600 to the head of the relevant department.

Uploaded by

Sourajit Pattanaik
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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UTKAL UNIVERSITY, BHUBANESWAR, ODISHA

P.G. ADMISSION FORM


Name of the Department:
Course
Recent Passport size
Name Photograph
Date of Birth Mother Tongue (self-attested)
(DD/MM/YYYY)
Gender Marital Status
Nationality Blood Group
Religion
Father’s Name Occupation
Mother’s Name Occupation
DD/BC/SBI Collect receipt No.: Date:
Address for Correspondence Permanent Address
Village/Street Village/Street
Post Post
Police Station Police Station
District District
State State
Pin/Zip Pin/Zip
e-mail Address
Contact No(s).
Academic History of the Candidate
Degree/ Board/ Institute/ University Max. Secured % Year of Division/ Main/Optional
Diploma University Marks Marks Passing Class Subjects
(Passed)

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Honours Details:

Maximum Marks Marks secured % of Marks Distinction


in Hons. in Hons. in Hons. (Y/ N)

Category & Reservation Details


Category (SC/ST/SEBC/General)
Mention if differently abled (Yes/No)
NCC/ NSS
Defense (In-service/Ex-service)
Sports personnel (University level/State level/International level)
If admitted, I proposed to reside

List of Enclosures (Please put √ mark)


(1) Mark sheets and certificates of all examinations.
(2) Caste Certificate issued by the competent authority.
(3) Person With Disability (PWD) Certificate issued by the competent authority.
(4) Two copies of self-attested passport size photograph attached along with the form.
(5) Sports certificate attested by competent authority–Director of Sports/ Sports Council of the
University countersigned by the Principal/HOD of the College/Department.
(6) Ex-service men/In-service men Certificate (if any) issued by the competent authority.
(7) NSS/NCC Certificate (if any) issued by the competent authority.
(8)
(9)
(10)

UNDERTAKING/DECLARATION
I solemnly affirm that the information furnished above is true and correct in all respect to the best of my
knowledge and belief. I have not concealed any information. I undertake that if any information herein
is found to be incorrect or false, I shall be liable for action as per rules in force.

Date:
Place: Signature of the Candidate

Information for the Applicant


Applicant needs to send the application form along with the necessary enclosures mentioned below by
speed/registered post or in person to the Head/ Coordinator of the respective Department. Demand Draft
for Rs.600/- (Six hundred only) be made in any Nationalized Bank in favour of “Administrative
Officer, P.G. Teaching Departments, Utkal University” payable at Bhubaneswar.

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