1. Programme Applied For :

1a. Branch (if any):

2. Details of Qualifying Entrance Examination :

Name of Qualifying Entrance Examination Month & Year Score/Rank

3. Personal Details :

Name (Mr. / Ms.) : DD MM YY (Years) (M/F) (Married/Unmarried) Date of Birth : Age : Gender : Marital Status :

Category : Nationality :

4. Contact Details :

Correspondence Address : .............................................................................................................................................................

.............................................................................................................................................. Pin Code :

Phone No : ......................................... Mobile No : .............................................. Mail ID : ..............................................................

Permanent Address : .......................................................................................................................................................................

.............................................................................................................................................. Pin Code :

Phone No : ............................................................................ Mobile No : ....................................................................................

5. Details of Contact Person Incase of Emergency

Name : .............................................................................................................. Phone/Mobile No. : ...........................................

Address : .................................................................................................................................................................................................

..................................................................................................................................................................................................................

6. Parents Details :

Parent’s Name (Father & Mother) Occupation Phone No Mobile No Mail ID

Affix your recent Passport size

photograph not earlier than 6 month

Note: •Pleasereadtheformcarefullybeforefillingit.

•Filltheformincapital letters.

•Attachtherequireddocuments(Xeroxcopy)asmentionedineducationalqualification.

•AttachtheResult/Score/Rankofqualifyingexamination(ifapplicable).

Form No. JU/2014-

Registration No.

(to be given by the office)

• Approved by UGC • Member AIU • An ISO 9001:2008 Certified Institution

Application for Admission

(for programme list see the Information

7. Educational Qualifications:

Examination Passed

Name of The Stream

Name of the School / College and Board / University

Year of passing Subject Studied Marks

ObtainedMaximum

Marks% of

Marks

10th

12th

Graduation

Post Graduation

Any other Qualification

8. Awards and Achievements (if any) :

.............................................................................................................................................................................................................

.............................................................................................................................................................................................................

.............................................................................................................................................................................................................

.............................................................................................................................................................................................................

9. Participation in Extracurricular Activities :

.............................................................................................................................................................................................................

.............................................................................................................................................................................................................

.............................................................................................................................................................................................................

.............................................................................................................................................................................................................

10. From where did you come to know about Jagan Nath University.

Friend’s/Family Newspaper Internet Radio/T.V. Magazine

Please specify the name of magazine / newspaper

Any other (Please specify) : ___________________________________________________________________________

11. Employment History :

Work Experience : Yes No (If, Yes Total Experience : Years ................................. Months ..................................

Organization / Company Detail :

Name of Company Address Duration Designation Nature of Work Salary Drawn

12. Payment Details (applicable for downloaded forms only):

DD No. DD Date Amount Name & Address of Bank

Jagan Nath University

Sir,

I wish to apply for admission to Jagan Nath University, Jaipur and promise to abide by the Rules & Regulations of the University. I certify that the information given by me in this application form is correct and complete to the best of my knowledge and belief. I agree to be assigned for classes to any of the campuses of the University in Jaipur without any prior notice. I understand and agree that misrepresentation, concealment or omission of any fact will justify the denial or cancellation of my admission, or expulsion from the University. I am aware that fees once paid by me is not refundable for any reason whatsoever. I further declare that I shall submit myself to the disciplinary jurisdiction of the University.I have read and understand all the terms and conditions for the admission mentioned in the prospectus and agreeto abide by them.

Signature of the Applicant

Declaration:

Place: __________________ Date:___________________

Place: __________________ Date:___________________

Parent’s Declaration

I undertake that my son/daughter ________________________________________ applying for admission to __________________________________

course will be subjected to the University Disciplinary Rules and Regulation. I further undertake to pay

all the dues of the University in time.

Signature of the Parent

AdmissionWe recommended the applicant for provisional admission to _________________________________________________ after having verified his/her original certificates and accept prescribed fees from the applicant. However, his/her admission is subject to the approval of the Governing Body of

the University.

Admission Incharge Registrar

Specimen Signatureof the candidate

Course Applied for :

Registration No./Roll No. :

Test Centre : Date : Time :

Name : Mr./Ms. _________________________________________________________________________

Father’s : Name:_________________________________________________________________________

Address : _______________________________________________________________________________

_________________________________________________________________ Pin Code

Ph. No. ____________________________________ Mobile No. _________________________________

Acknowledgement Invigilators Signature

Affix your recent colour passport size

photograph

Admit Card • Approved by UGC • Member AIU • An ISO 9001:2008 Certified Institution

Form No. JU/2014-

(Students Copy*)

*Kindly retain this copy for future use Turn back for Rules and Regulations

Rules & RegulationsNoN-RefuNd of fees

The fees once paid are not refundable for any reason whatsoever. Only Security Deposit will be refunded after making necessary adjustments as required.

CaNCellatioN of admissioN

Jagan Nath University reserves its right to cancel the admission of admitted student under any of the following circumstances:

• If the fee is not deposited by the stipulated date.• If the candidate fails to join a particular programme by the

stipulated date, after the fee has been paid.• If the candidate fails to furnish the proof of the stipulated

minimum qualification. • If any student is found to be misbehaving or any other issue

regarding discipline at any point of time.

atteNdaNCe

Minimum 75% attendance is compulsory to complete the course.

JuRisdiCtioN

Any dispute pertaining to admission or any other matter concerning a student or alumnus of Jagan Nath University shall be subject to the jurisdiction of the Jaipur Court only.

limitatioN Clause

No dispute shall be raised after the expiry of 30 days from the date on which the process of admission and / or selection is completed.

agReemeNt Clause

All admitted students shall be bound by the above mentioned Rules & Regulations of Jagan Nath University.

Chaksu CampusNH - 12, Chaksu By Pass, Tonk Road, Jaipur-303901

Sitapura CampusPlot No. IP - 2 & 3, Phase IV, Sitapura Industrial Area, Opp. Chokhi Dhani, Jaipur-302022

Contact No.Phone: +91-141-3020500, 4071551

Fax: +91-141-3020538E-Mail: admission@jagannathuniversity.org

www.jagannathuniversity.org