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INTERNATIONAL APPLICANTS

VISVA-BHARATISANTINIKETAN -731235

WEST BENGAL, INDIA

Attach one recently

taken passport size

photograph duly

attested.

Application for Admission to ________________________________Seesion : 200 - 200

(Write the nane of the Institute)

[ Please tick ( ) in the appropriate place and strike out which is not applicable ]

1. Admission sought for

a) Programme of study :

b) Major Subject :

c) Subsidiary or other Subject (s), if any :

2. Name in Full (In BLOCK LETTERS) :

3. Sex : Male Female 4. Nationality :

4. a) Whether a person of Indian Origin Yes No

b) Whether Non-Resident Indian Yes No

c) Mother Tongue

5. a) Date of Birth : Day Month Year

b) Place of Birth :

6. Hostel Accommodation :Necessary Not necessary

7. Address

For correspondence Permanent Father/Mother/ Apersons address

Address Spouse/ who can be

Guardians contacted in case

address of emergency

Name

Location

City

Post Office

Postal Code

State

Country

Telephone No. (i)

Cellphone No. (ii)

Fax No.

E-mail

9. Language Known Can Speak Can Read Can Write

Serial No......................................

D.D. /Cash Coupon No ..............

DATE : .......................................

P. T. O.

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10. a) Present Occupation :

b) Designation, if employed :

c) Annual Income (in U.S. Dollar) :

d) Name, contact address, telephone, fax & e-mail of employer :

11. In case, Financially supported from any organization / Individual :

a) Name of the Organization / Institute :

b) Address :

12. Passport No. : Date of Issue :

Place of issue : Valid till :

13. Visa : Type No.

Place of issue : Date of Issue :

14. Details of the Course (s) of studies taken by the candidate earlier or currently taken in Visva-Bharati :

Year Course of Department Institute / Registration Year Result

of Study Bhavana No. (Division /

Study Class)

15. Whether the applicant is prepared to take an entrance test at Visva-Bharati : Yes No

16. Purpose of Study :

17. Special interest, if any :

18. Institutions where you have studied since Secondary level education :

Level / Course of Study Year Name of the Address Telephone No. /

of School /College Fax No./e-mail

passing Institue etc.

(a) (b) (c) (d) (e)

P. T. O.

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19. Referee Particulars :

Name Designation Contact Address Telephone No.

Referee 1

Referee 2

Referee 3

20. Only for Fine Arts/ Performing Arts discipline :

Details of the attached photography/ CD/ Cassettes, etc. of works.

21, Only for Research programme (Ph.D/D.Litt./D.sc.etc.) :

(A) Broad field of proposed Research Work:

(A synopsis of the proposed work is

to be attached)

(B) Tentative Title of the proposed thesis :

(to be given in the language in which

the thesis will be prepared as well as

its English translation )

(C) Named of Supervisor(s) :

(If the candidate has any choice)

(D) (i) Research/Field experience, if any :

(E) Permission from Government :

Permission Letter No. :

Issued by :

Declaration :

1. The statements made above are tfrue to my knowledge and belief. In case any entry or information or document (s)

is /are found to be false/fake, this shall entail automatic cancellation of my admission besides rendering me lible to

such action as the university may deem proper.

2. If selected,

(a) I shall abide by the rules and regulations of Visva-Bharati and take part in the traditional functions and festivals

of Visvs-Bharati

(b) I shall not engage in (i) political activities, (ii) activities prejudicial to the interest of th eUniversity as well as

to India (iii) activities which could be embarrassing to the relations between India and any foreign country.

(c) I shall abide by the rules of discipline and proper conduct which may be applicable.

(d) I shall not leave the Headquarters without prior permission of the concerned University authority.

Signature of the Applicant

(1)

(2)

Dated

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CHECK LIST for the Applicant :

Please put (tick) marks.(1) Whether entered All relevant particulars in the Applicant From YES NO

(2) ATTACHMENTS

(i) Passport-size photograph duly attested YES NO

(ii) Educational Documents attached (put (tick marks) :

Level of Photocopies of Academic Equivalence Remarks

Examination Marksheets & Transcripts Certificate

Certificates

Whether Whether Whether

Attested Attested AttestedSecondary (10 Yrs.)

or Level or

equivalent

High er Secondary /

Senior School Leaving

Certificate or equivalent

(10+2 Yr.)

Bachelors Degree/

Graduation or

equivalent

(B.A., B.Sc., B.F.A.,

B.Mus. etc.)

Masters Degree

or equivalent

(M.A., M.F.A.,

M.Mus. etc.)

Any other degree/

diploma

(3) Medical/Health Certificate attached : YES NO

(4) Birth Certificate attached : YES NO

(5) Two Referees Certificates attached : YES NO

(6) No Objection Certificate/School or College Leaving Certificate YES NO

(if already studying in an Indian Institute) attached :

(7) Additional attachments :

(A) For Fine Arts Coursesonly

At least 6 colour photographs attached YES NO

Whether attested YES NO

(B) For Performing Arts CoursesonlyAudio-visual/Audio CDs/Cassettes attached YES NO

Whether attested YES NO

(C) ForResearch/Ph.D./D.Sc./D.Litt.only

A short synopsis of the topic indicating

(i) the field of Research YES NO

(ii) Tentative title of the thesis YES NO

AND

No Objection Certificate from the employer, if the YES NO

applicant is in employment :

Price Rs. 400.00 / 10 U.S. Dollar only.