REGULAR ADMISSION FORM
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Personal Information
*Apply For Under Graduate
*Name of the applicant
*(First Name) (Middle Name) (Last Name)
*Date of Birth
Age
*Gender Male Female Religion
*Nationality *Mother Tongue
*Blood Group *Do You Want to Apply For Hostel ? Yes No
Aadhaar No

Reservation Details

*State

*Category
*PH/OH if Applicable *ESM/SDP/COM if Applicable
*Country

Present Address
*Address Line 1 *Country
Address Line 2 *State
Address Line 3 *City
*Pincode
*Permanent Address Same as Present Address ? Yes No
Permanent Address
*Address Line 1 *Country
Address Line 2 *State
Address Line 3 *City
*Pincode
Contact Details
Landline No. *Email Id
*Mobile No.1 *Confirm Email Id
Mobile No.2

Family Details
*Father's Full Name *Mother's Full Name
Father's Telephone (Mobile No.)
You have applied for:




  
 











  
 
Document Upload
  *Please upload your Photo here.
  *Please upload your Signature here.
  *Please upload 10th/Matric Marksheet here.
  *Please upload 10th/Matric Certificate here.
  *Please upload +2/12th/Diploma Marksheet here.
  Please upload +2/12th/Diploma Certificate here.
  
 
Payment Details
 
Note : Demand Draft : To be made in Favour of "Comptroller of Finance, G.M. University, Sambalpur", payable at Sambalpur
Cash : Need to visit university to deposit the amount in the cash counter
*Payment Mode Demand Draft Online
AMOUNT (RS)
   
Note : After completion of Form, please courier the print of the completed application form and DD at the following address : Gangadhar Meher University, Sambalpur, Odisha, Pin-768004.

Declaration by the Candidate
 


  1. I fulfill all the eligibility conditions as laid down in the advertisement/prospectus.
  2. I have not been debarred from taking admission in any educational institution in India.
  3. If admitted, I will abide by the disciplinary and other rules and regulations of the Gangadhar Meher University, Sambalpur, framed and enforced from time to time.
  4. I promise not to indulge in ragging or any other undesirable activity against University norms or prejudicial to the interests of the University, which will attract disciplinary action.
  5. The information given by me in my application form is true to the best of my knowledge and belief.

Place:_________________
Date:_________________                                                                                        Student's Signature:_________________
 

Declaration by the Parent
 


I _______________________________ declare that the particulars furnished by my son/daughter in this application form are correct to best of my knowledge. I undertake and bind myself to pay on behalf of my son daughter such fees, charges, etc., which Gangadhar Meher University, Sambalpur, may levy from time to time and in the event of failure on my part and / or on the part of my son/daughter in this regard, the Vice - Chancellor, Gangadhar Meher University, Sambalpur, may take such action against my son/daughter, as he may deem fit and necessary.
I also undertake to endure his/her good and disciplinary behavior.
Place:_________________
Date:_________________                                                                                        Parent's Signature:_________________

 
    I Agree
 
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