GOVERNMENT AUTONOMOUS COLLEGE, PANPOSH, ROURKELA APPLICANT INFORMATION (FILL UP IN BLOCK LETTER) DD MM YYYY Mother Tongue

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1 GOVERNMENT AUTONOMOUS COLLEGE, PANPOSH, ROURKELA APPLICATION-CUM-ENTRANCE FORM FOR ADMISSION TO POST GRADUATE COURSES FOR OFFICE USE ONLY ENTRANCE ROLL. NO. COLLEGE ROLL No. SUBJECT 18PENT. / / (Subject) (Sl. No.) SPACE FOR PASTE RECENT PASSPORT SIZE PHOTOGRAPH (SELF ATTESTED) Signature of the OIC, Admission Sign. of the Principal APPLICANT INFORMATION (FILL UP IN BLOCK LETTER) NAME OF THE APPLICANT APPLIED POST GRADUATE SUBJECT DOB Gender(M/F) Religion Category DD MM YYYY Mother Tongue Blood Group Contact No Id. MONEY RECEIPT DETAILS MR No. Date Amount Name of the Father: - Name of the Mother:- Name of the Guardian: - (If, Parents not alive) PARENTS / GUARDIAN INFORMATION CORRESPONDENCE ADDRESS PERMANENET DISTRICT STATE PIN DISTRICT STATE PIN

2 ACADEMIC RECORDS SL. NO. NAME OF EXAM PASSED NAME OF INSTITUTE NAME OF BOARD/ UNIVERSITY YEAR OF PASSING MARK SECURED TOTAL MARK LAST EXAMINATION RECORD SUBJECT NAME TYPE FULL MARK SECURED MARK %AGE * Type Stands For: - (Hons/ Elective/ Minor Elective/ Elective A/ Elective B/ Compulsory/ Optional etc) If Hostel Accommodation required (Put Y) DECLARATION belief. I hereby declare that the above given information is correct to the best of my knowledge and Date: Place: Full Signature of Applicant UNDERTAKING (Degree Result waiting Student.) I Sri / Kumari / Srimati want to inform you that my final year/ Degree semester result is awaited. I hereby undertake that I will submit the marksheet immediately on or before Entrance Examination as and when required for Admission into PG. Full Signature of Applicant

3 UNDERTAKING TO BE SIGNED BY THE STUDENT AND HIS/ HER FATHER & MOTHER. I do hereby undertake to abide by the following rules of the College. i) I shall come to College campus always with valid Identity Card and in prescribed Uniform. ii) iii) iv) I shall never violate any of the rules regarding discipline inside the college campus and in the Hostels. I shall attend my classes regularly and in case of shortage of attendance I shall not claim to be sent up to appear at the College Examination. I shall not in any way be involved in causing any kind of damage to the College property. v) I shall help in keeping the College building and campus clean. I shall keep my cycle/ vehicle with extra lock in the appropriate place in a neat and orderly manner. vi) I shall not indulge in any kind of INDECENT AND IMMORAL activities inside the College premises and near the Hostels which will in any way defame the Institution. If I am found to have violated any of the rules mentioned above, action deemed fit may be taken against me by the College authorities. FULL SIGNATIRE OF THE STUDENT Countersigned by: Full Signature of Father Full Signature of Mother Postal Address of Father/ Mother with Pin Code: Contact Mobile No. of Father/ Mother: (This undertaking must be submitted at the time of Admission)

4 UNDERTAKING BY THE STUDENT REGARDING PROHIBITION OF RAGGING I Sri/ Kumari son/ daughter of Sri/ Smt. do hereby undertake that I am aware of the Law regarding prohibition of ragging as well as the punishments and that I, if found guilty of the offence of ragging and / or abetting ragging, am liable to be punished appropriately. Full Signature of the Student UNDERTAKING BY THE PARENT/ GUARDIAN REGARDING PROHIBITION OF RAGGING I Sri/ Kumari Father/ Mother of Sri/ Smt. do hereby undertake that I am aware of the Law regarding prohibition of ragging as well as the punishments and that I, agree to abide by the punishment meted out to my ward in case he/ She is found guilty of ragging and/ or abetting ragging. Full Signature of the Parent/ Guardian N.B.: i) Ragging means the following: Any disorderly conduct whether by words spoken or written or by an act which has the effect of teasing or handling with rudeness, any other students including in rowdy or indiscipline activities which cause or is likely to cause annoyance, hardship or psychological harm or to raise fear or apprehension thereof in a fresh or a junior student or asking the students to do any act or perform something which such student will not in the ordinary course and which has to effect of causing or generating a sense of shame embarrassment so as to adversely affect the physique or psyche of a fresher or a junior student. ii) Punishable ingredients of Ragging: *Abetment to ragging * Criminal conspiracy to rag * unlawful assembly or rioting while ragging *Public nuisance created during ragging * Violation of decency and morals through rapping * Injury to body, hurt or grievous hurt * Wrongful restraint * Wrongful confinement * Use of Criminal force * Assault as well as sexual offence or even unnatural offences * Extortion * Criminal trespass * offences against property * Criminal intimidation * Attempts to commit any or all of the above mentioned offences against the victim (s) * All other offences following from the definition of Ragging. (This undertaking must be submitted at the time of Admission)

GOVERNMENT AUTONOMOUS COLLEGE ROURKELA-769004 P.G. ENTRANCE 2018-19 ADMIT CARD SPACE FOR PASTE RECENT PASSPORT SIZE PHOTOGRAPH (SELF ATTESTED) APPLIED P.

) (FOR OFFICE USE ONLY) DATE OF ENTRANCE TEST: TIME OF WRITTEN TEST: 10/06/2018 (SUNDAY) SITTING

5 GOVERNMENT AUTONOMOUS COLLEGE ROURKELA P.G. ENTRANCE ADMIT CARD SPACE FOR PASTE RECENT PASSPORT SIZE PHOTOGRAPH (SELF ATTESTED) APPLIED P.G SUBJECT NAME OF THE APPLICANT ENTRANCE ROLL NO. 18PENT. / / (Subject) (Sl. No.) (FOR OFFICE USE ONLY) DATE OF ENTRANCE TEST: TIME OF WRITTEN TEST: 10/06/2018 (SUNDAY) SITTING TIME P.G. SUBJECTS 1 ST 09 AM TO 10 AM BOT, ZOOL, CHEM, PHY, MATH, STAT, COM, COMP. SC. 2 ND 11 AM TO 12 NOON ODIA, HINDI, ENG, PSY, POL.SC., ECO, HIST, EDU, SOC. NB: Date of Viva-voce will be intimated on the day of Entrance Test. (Full Signature of the Applicant) SECRETARY, P.G. ADMISSION COMMITTEE GOVT. AUTO. COLLEGE, ROURKELA.

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Application No. : BILASPUR UNIVERSITY BILASPUR (C.G.) 495001 fcykliqj fo ofo ky;] fcykliqj ¼N-x-½ 495001 Affix your Recent Passport Size Photograph APPLICATION FORM FOR ADMISSION SESSION : 2017-18 A] Result