REGISTRATION APPLICATION FORM

University

*Mandatory fields

Applying For

Course *

Select any Course

Subject

Applicant's Personal Details

1. Applicant's full name *

( Full name as per the highest / latest qualification certificate or legal certificate )

Applicant's full name can not be left blank

2. Mother's Name *

( Full Name As Per Educational/Legal Certificate )

Mother's Name can not be left blank

3. Father's / Husband's Name

( Full Name As Per Educational/Legal Certificate )

4. Guardian's Name *

( Full Name As Per Educational/Legal Certificate )

Guardian's Name can not be left blank

5. Relationship with Guardian *

Relation with can not be left blank

6. Guardian's Mobile No. *

Guardian's Mobile No. can not be left blank

7. Gender *

Male

Female

Transgender

Do not want to disclose

Select any Gender

8. Date of Birth *(dd-mm-yyyy)

( As per high school certificate in 'dd-mm-yyyy' format. i.e. '01-Jan-1990' )

Date of Birth can not be left blank
Please Enter a valid date in the format (dd-Mon-yyyy)

9. Nationality *

Nationality can not be left blank
Nationality can not be left blank

10. Category *

Select any Category

11. Marital Status *

Select any Marital Status

12. DAP (Differently Abled Person) *

Yes

Select any one

13. Aadhaar Number *

Aadhar Number can not be left blank

14. Blood Group *

Blood Group can not be left blank

Admission Details

University Last Attended *

Select any one
University can not be left blank

College Last Attended *

College Last attended can not be left blank

B.A./B.Sc./B.Com. (Hons) Examination *

Passed

Select any one

Year of Passing B.A./B.Sc./B.Com. (Hons) Examination *

Registration No. *

Registration No. can not be left blank

Registration Year *

Marks Obtained in the Previous Examinations*

Sl No.	Qualifying Examination	Year	Subject	Full Marks	Marks Obtained

Extra-Curricular Activities, if any

Contact Details

Mobile Number *

+91

Mobile Number can not be left blank
10 DigitNumber Only

Email Address *

Email Address can not be left blank
Email is not properly formed.

Permanent Address Details

Address Line 1 *

Address Line1 can not be left blank

Address Line 2

Address Line 3

City Name *

City Name can not be left blank

Enter State *

State can not be left blank

Enter District *

District can not be left blank

Country *

Select any Country

State *

Select any State

District *

Select any District

Pin Code *

Pin Code can not be left blank
6 DigitNumber Only

Correspondence Details

Address Line 1 *

Address Line1 can not be left blank

Address Line 2

Address Line 3

City Name *

City Name can not be left blank

Enter State *

State can not be left blank

Enter District *

District can not be left blank

Country *

Select any Country

State *

Select any State

District *

Select any District

Pin Code *

Pin Code can not be left blank
6 DigitNumber Only

Educational Qualification Details

Upload Marksheet Both Page (Please Upload Madhyamik OR Equivalent,H.S OR Equivalent and Graduation in one file) *

( PDF,JPG,JPEG,GIF,PNG file with size upto 1 MB )

No file is selected

Identification Details

Upload Photo *

( JPG,JPEG,GIF,PNG image with size upto 75 KB )

No file is selected

Upload Signature *

( JPG,JPEG,GIF,PNG image with size upto 75 KB )

No file is selected

Please enter the following captcha you see into the text box below.*

Captcha

Text can not be left blank

Declaration

I declare that all the information furnished above are correct and true and that if any of the information furnished proves to be materially false or incorrect, either wholly or partly, the University may cancel my admission or take such other action as may be deemed fit. I shall not indulge in any act of ragging. If I am found guilty of any aspect of ragging, I shall be punished as per Provisions of the UGC Regulations and /or as per law in force.

SADHU RAM CHAND MURMU UNIVERSITY OF JHARGRAM