GURUKULA KANGRI VISHWAVIDYALAYA, HARIDWAR-249404
(Deemed to be University U/s 3 of UGC Act 1956)
ICR Application Form For Entrance Examination 2015
Important Instructions:
Received cash/Bank Draft No. ........................................................
1. Kindly read the instructions given on the reverse side of this form and in
Rs. ............................................... Date ...........................................
the information brochure carefully before ﬁlling this application form
and also ensure the eligibility etc.
Univ. Ofﬁce
2. Use Black / Blue pen to ﬁll this application form.
3. Tick ( ) in the appropriate box wherever given.
4. Do not attach any documents such as marksheet, certiﬁcates etc with this
Application No.
applications form.
(Tick ( ) the appropriate box for the Course applied for )
st
nd
(a) B. Pharm. (for boys only) 1 Yr.
2 Yr.
(b) B.P.Ed. (for boys only)
(d) M.Sc. (for boys & girls)
Maths
Physics
Chemistry
Microbiology
(c) MCA (for boys & girls)
Environmental Science
1. Full name of the candidate (in CAPITAL letters)
2. Father’s / Guardian’s Name (in CAPITAL letters)
3. Nationality
4. Gender
Indian
Male
Non Indian
Female
6. Date of Birth
DAY
MONTH
YEAR
5. Category
General
ST
Person with disability
OBC
(PWD)
Staff Ward (SW)
SC
7. Whether Qualifying examination has been passed/appeared from
Gurukula Kangri Vishwavidyala, Haridwar
YES
8. Name & year of passing of the qualifying examination
NO
YEAR
9. Name and address of College/University of qualifying examination
10. Percentage of Marks 10 th
12 th
11. Preference for Examination Centre (Tick ( ) your choice in the box)
02. Chandigarh
01. Bhopal
12. Address for Correspondence (Mailing Address)
03. Dehradun
06. Lucknow
05. Haridwar
04. Delhi
Graduation
13. Photo
Afﬁx ﬁrmly only a resent
coloured Photograph of
3.5 cm. x 4.5 cm. size
14. Landline/ Mob. No.
(Including STD, if any)
15. Email :.....................................
16. Signature of the Candidate
Pin
17. Declaration by the Candidate : I hereby solemnly and sincerely declare that all the information stated in this application are true to my knowledge and
belief. I have read the information brochure and the admission procedure and I shall abide by the terms and conditions therein. In the event of suppression or distortion of
any fact like Qualiﬁcation, Nationality etc. made in my admission to GURUKULA KANGRI VISHWAVIDYALAYA, HARIDWAR is liable to cancellation. I have carefully
checked the eligibility criteria as mentioned in the Information Brochure and I fulﬁll the eligibility for the course applied. In case it is found that I do not fulﬁll the eligibility, my
candidature / admission shall automatically stand cancelled at any stage during or after admission process. I also understand that the decision of the authorities of the GKV
regarding my admission will be ﬁnal and I shall abide by their decision, Further, if admitted, I promise to abide by the rules and regulations of the Vishwavidyalaya as
applicable during the course of study. I am aware that ragging is banned in GKV and if found guilty, I shall be liable for punishment as per rules.
Place......................
Date........................
Countersigned by Parent/Guardian
Signature of the Candidate
Instructions for Completing the Application Form
1. Name of the candidate: Write your full name in Capital letters as given in your 10thstandard certiﬁcate.
Write only one letter in one box. Leave one blank box between any two parts of the name, as shown in the
example below.
R A V I
K UM A R
S H A RM A
2.
Name of the Father/Guardian : Write the name of your father/guardian exactly as in your Board
certiﬁcate. Leave a box blank between any two parts of the name.
3.
Nationality : Tick ( ) the appropriate box.
4.
Gender : Tick ( ) the appropriate box.
5.
Category : Tick ( ) the appropriate box.
6.
Date of Birth : Enter the date, month and year of your birth as per the English Calender and as recorded
in your 10th standard certiﬁcate.
7.
Whether Qualifying examination has been passed/appeared from Gurukula Kangri Vishwavidyalaya,
Haridwar : Tick ( ) the appropriate box.
8.
Name and year of passing of the qualifying examination : Write the name of the qualifying examination.
Enter the year of passing the qualifying examination. For example, if passing year is 2014, write 2014.
Those who are appearing for qualifying examination in 2015 should write 2015 here
9.
Name and address of the College/University of the Qualifying Examination : Write the name and
complete postal address of College/University from which you have passed / appeared in the qualifying
examination.
10. Percentage of Marks : Write the actual percentage of aggregate marks obtained in 10 th, 12 thstandard and
Graduation. For example if the percentage is 62.43, it should be written as:
6 2
4 3
11. Examination Center : Tick ( ) your choice in the appropriate box.
Note- Examination Center may be Changed, if the number of candidate is less than 50.
12. Mailing address : Write your address within the prescribed area in the application form for
correspondence.
13. Photograph of the Candidate : Paste ( do not staple ) a recent ( not more than two months old ) colored
photograph in the given space.
14. Land line / Mobile No. : Write ( if any ) your contact Land line / mobile number on which a message ( if
any ) can be left for you. Use the boxes in the ﬁrst group for STD code and the boxes in the second group
for the telephone number. For example, the number 0118-4512001 may be shown as below :
0 1 1 8
4 5 1 2 0 0 1
15. Email : Write your Email ID in the appropriate place.
16. Signature of the Candidate : Sign in Black / Blue Ball Pen Ink within the box provided. Your signature
must not over ow or touch the border of the box provided.
17. Declaration by the Candidate : The candidate must sign the declaration. The place and date should also
be mentioned. Application form without signature or with different signatures at two places will be
treated as incomplete and will be rejected. Your application should be countersigned by your parent /
guradian.