CENTRAL UNIVERSITY OF HARYANA

Check List for Admission 2019-20

Programme (ln Which Admission Sought): ………………………………………………………………………………….

Student Name: …………………………………………………………………………………………………………………………..

CUCET Application lD No.: ……………………………………………………………………………….………………………..

CUCET Score: …………………………………………………………………………………………………………………………..

Actual Category:……………………………………………………………………………………………………………………..

Admitted Category:………………………………………………………………………………………..……………………..

Email lD: ………………………………………………………………………………..……………………..

Contact No.:……………………………………………………………………….……………………..
Documents submitted by the Candidate:

Please () where applicable. YES/NO

1. CUCET-2019 Score Card (As applicable)
2. Matriculation (Date of Birth Certificate) Certificate & Marksheet
3. 10+2 Certificate & Marksheet
4. Graduation Certificate& Marksheet
5. Post-Graduation Certificate and Marksheet
6. Certificate in support of reservation (SC/ST/OBC-NCL/EWS)
7. Fee Payment Receipt (Downloaded from Counselling Website)
8. Character Certificate
9. UGC NET/SLET/JRF/ASRB/Teacher FeIlowship/M.Phil. Certificate (If Applicable)
10. Disability Certificate (For PWD Candidates)
11. Sports Certificate/Extra Curricular Activities Certificate (If Available)
12. Passport Size Photograph (4 Nos.)
13. Migration Certificate/Transfer Certificate
14. Anti-Ragging Undertaking (to be filled online, available on UGC website)
15. Any other Certificate (Undertaking in case some certificate is not submitted)

Recommendations of the Admission Committee:

2. Student is admitted to :....................................Course provisionally subject to submission of following documents:
1 2

3 4

5 6

Signature of Admission Committee Members:

*Note: Last date for submission of qualifying degree/examination is 30th August 2019.
 CENTRAL UNIVERSITY OF HARYANA
(Established vide Act 25 (2009) of Parliament)
Jant-Pali, Mahendergarh, Haryana (Pin: 123029)
NAAC Accredited ‘A’ Grade University
ENROLLMENT FORM FOR UNDER GRADUATE/ POST GRADUATE/ RESEARCH PROGRAMMES
Academic Year 2019-20
NOTE:
(a) Read the information available on the University website carefully before filling the Enrollment form.
(b) The candidate shall be responsible for all entries. Attach all self-attested documents including copies of
certificates of previous examinations passed, mark sheets, category certificate, character certificate etc.
Before filling the Enrollment form, the candidates are advised to ensure their eligibility for the programme
applied for in accordance with the eligibility conditions for the various programmes available on the
University website. It will be the sole responsibility of the candidate to make sure that he/she fulfils all the
conditions prescribed for admission. The decision of the University with regard to admission, shall be final.
(c) Incomplete or unsigned forms shall be rejected summarily.
(d) Use only Blue/Black pen while filling the Form.
Paste Here One
Recent Passport
-----------To be filled in Capital Letters only----------- Size Color
Photograph (Self
1. Programme (UG/PG/RP) ……………………………… (Name of the Programme) Attested)
(DO NOT
2. Subject/Discipline/Branch: ………………………………………………………………………………… STAPLE)

3. (a) Actual Category (SC/ST/OBC /UR/EWS) (b) Category under which admission has
been made………………………… (UR/SC/ST/ OBC (NCL)/OBC/PWD/EWS/Sports, if any others, please
mention)……………………………………………………

(c) Sub Category, if PWD………………………………………………………..

4. CUCET Details: Roll No. …………………………… Application Id ………………………………. Marks Obtained…………………..

5. Candidate Name (In CAPITAL Letters): ……………………………………………………………………………………………………………….

6. Father’s Name: …………………………………………………… Mother’s Name: ..……………………………………………………………

7. Gender: Male Female Transgender Caste :

8. Nationality: Indian Other Name of the Country: …………………………………………………….

9. Religion: Hindu Muslim Christian Other

10. Aadhaar Number:

11. Date of Admission: ………………………… (dd/mm/yyyy)

12. Date of Birth: ……………………..(dd/mm/yyyy) Place of Birth: State ……………………………… Distt. ……………………………..
13. Blood Group: ………………………………………………......................................

14. PERMANENT ADDRESS MAILING ADDRESS

………………………………………………………………………………… ……………………………………………………………………………
………………………………………………………………………………… ……………………………………………………………………………..
………………………………………………………………………………… …………………………………………………………………………….
……………………………………………………………………………….. ……………………………………………………………………………..
PIN CODE………………………………………………………………… PIN CODE………………………………………………………………
Tel. No. / Mobile ……………………………………………………. Tel. No. / Mobile ……………………………………………………
Email: …………………………………………………………………….. Email: ………………………………………………………………….

15. Academic Qualifications (All the columns should be legibly filled):

Qualifying Examination: …………………… Result/Percentage of marks/CGPA in Qualifying Examination: ……………

% of
Examination Board/ Year of Max Marks Subjects Studied and
Marks &
Passed University Passing Marks Obt. Passed
Division
/CGPA
Matric

Inter/ SSC/ 10+2

Graduation
..........................
Post-Graduation
..........................
M.Phil.

NET/JRF/SLET/ Roll No. Year/ Subject If holding the Fellowship, the date from
GATE/M.Phil Month which it is held:
Date…………… Month…………..
Year……….
Any Other
Examination

a) Give details of publications & research work carried out, if any. (Please attach separate list, if required)
…………………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………..……………………….
………………………………………………………………………………………………………………………………………………………………….

b) Under which clause (as per the Ph.D. admission notification) have you been admitted:

Exempted Entrance Qualified

Type of exemption (if any): (NET/JRF/M.Phil/SLET etc.) ……………………………………………………………………..

 c) Work Experience, if any……………………………………………………………………………………………………………………………..

………………………………………………………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………………………………………………….

d) State if there is any gap in your studies. Give period, reasons etc.:

..……………………………………………………………………………………….......………………………………………………………………………
Any other relevant information:
………..…………………………………………………………………………………………………...…………………………………………………..…………………
………………………………...………………………………………………………….………………………………………...……………………………………………

UNDERTAKING BY THE CANDIDATE

I solemnly affirm that the information furnished above is true and correct in all respects. I have neither concealed nor
fabricated any information. In case any information in this form is found to be false or incorrect at any time (during or
after completion of the programme), this shall entail automatic cancellation of my admission, if granted, cancellation
of the degree if awarded, besides rendering me liable to such an action as the University may deem fit. In the event
of any medical or other emergency, my parent/s or Guardian may be contacted at the address given below:

Name and address of local guardian/Parents (if any)………………………………………………………………………………………………

Mobile No. .………………………………, Phone No. ………………………………….. Email ID:…………………………………………………….

Place: Signature of the Candidate

Date

Signature of Head/In-charge of the Department

For Office Use

(To record details of all the transactions/alterations/development to take place after the enrolment)
 UNDERTAKING

I, ……………………………………………. Son/Daughter/Wife of …………………………………

having CUCET APPLICATION ID………………………provisionally admitted in the
programme……..……............. of Department of ………………………………..hereby declare
that I will submit the following document/s (whichever is/are applicable) on or before 30th
August 2019:

(1) Qualifying Degree/Result ( )

(2) Supporting document in respect of reservation
(SC/ST/OBC-NCL/PWD/EWS/ESM etc.) ( )
(3) Original Migration/Transfer Certificate ( )
(4) Any Other………………………………………….. ( )

I have been apprised by the university that my Provisional admission will be cancelled if I
am not able to submit the above mentioned documents by due date.

Signature of candidate

Name and Signature of Admission Committee

1. 2. 3.
 UNDERTAKING
(FOR GAP YEAR)

I, …………………………………………… Son/Daughter/Wife of …………………………………

having CUCET APPLICATION ID………………………registered for the
programme……..……………. of Department of ………………………………..hereby declare that
I passed the qualifying examination in ……………..(year) and after that I was engaged in
……………………………………………………………………………………………………………………
……………………………..for the period of …………….(year) till the date of admission, and that
I have not taken admission in any course in any other Institute/College/University for the
current academic year. I also declare that any wrong information in this regard make me
liable for cancellation of my admission/ Degree if awarded with immediate effect.

Signature of candidate

Name and Signature of Admission Committee

1.

2.

3.