Haryana Vishwakarma Skill University (State University enacted under Government of Haryana Act. 25, 2016)

Haryana Vishwakarma Skill University

APPLICATION FORM

1. Course Name:____________________________________________________

2. Name of the Candidate: Mr./Ms.____________________________________ (As per Matriculation certificate) in Capital letters

3. Father’s Name: Sh.________________________________________ (As per Matriculation certificate) in Capital letters

4. Mother’s Name: Smt.______________________________________ (As per Matriculation certificate) in Capital letters

5. Date of Birth: ___ /___ /_______ 5. Gender: Male/Female___________

6. Nationality:__________________ 7. Religion:______________________

8. Aadhaar No (Desirable):____________________ 9. Contact No.:__________________

10. Category:__________ (Gen./BC-A/BC-B/SC) (HARYANA)/AIC/J&K migrant/Dudhola domicile

11. Correspondence Address: ______________________________

12. Person with Disabilities(DA/PwD)(Yes/No):___________

13. Belongs to any minority category(Yes/No)________ (If yes, please specify):__________________

14. Qualifying examination passed (Details of examination):___________ From (Haryana/Other state)__________ District:_______________ Year of pass________

15. Haryana Domicile (Yes/No):___________

16. Qualification Details:

Sr. No.

Examination Board/ University

Passing (Year & Month)

Subject/Trade/Specialization % of Marks/ Grade/CGPA

01 10th

02 10+2

03 Diploma

04 Others (Any)

Date: Candidate Signature

Place: Candidate Name:

Recent Coloured Photo

Haryana Vishwakarma Skill University (State University enacted under Government of Haryana Act. 25, 2016)

Haryana Vishwakarma Skill University

आवेदन पत्र

1.पाठ्यक्रम का नाम: ____________________________________________________

(माध्यममक/हाई सू्कल प्रमाण पत्र के अनुसार नननननननननन नननन)

2. आवेदक का नाम: ____________________________________

3. पपता का नाम: श्री_____________________ ___________________

4. माता का नाम: श्रीमती ______________________________________

5. जन्म तिति (dd/mm/yyyy के अनुसार): _____/_______/___________________

6. प िंग: पुरुष मपि ा

7. राष्ट्र ीयता: __________________

8. शे्रणी: __________ (Gen./ BC-A/ BC-B/ SC) (HARYANA) /AIC/ J&K Migrant/Dudhola Domicile

9. टेलीफ़ोन: __________________ 10. ई-मेल: _____________________________

10. पत्राचार का पता:________________________________________________________

______________________________________________________________________________

__________________________________________________________________________________

तिला: __________________ PIN: __________________ राज्य _______________________

11. पिक ािंग आवेदक______________________________(DA/PwD) (हााँ / नही ीं)

12. क्या आप अल्पसिंख्यक िगग के अिंतगगत आिे िै? (हााँ /नही ीं)

(यपि िािं, तो कृपया पनपिगष्ट् करें ): __________________

13. ययययययय परीक्षा का तववरण : कक्षा ___________ उत्तीणण होने का

वर्ण,___________________

(हररयाणा/अन्य राज्य)_______________ तिला:_____________________________________

Affix recent coloured

passport size photograph

Haryana Vishwakarma Skill University (State University enacted under Government of Haryana Act. 25, 2016)

Haryana Vishwakarma Skill University

14.हररयाणा अतिवासी (हााँ / नही ीं) ___________

15. शैक्षतणक योग्यिा तववरण:

Sr. No.

परीक्षा तशक्षा बोर्ण

उत्तीणण होने

का वर्ण

तवर्य अींक( % ) /

गे्रर् /

सीिीपीए (CGPA)

a. 8th

b. 10th

c. 10+2

d. तर्प्लोमा

e. अन्य

(योग्यिा)

ययययय के हस्ताक्षर

ययययय का नाम

तिति: स्िान: