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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: