Application Form for Admission in University Teaching Department
Session : 2019-20

Applicant's General Details
First Name *		Last Name *
Father's/Husband Name*		Father's/Husband Occupation*
Mother's Name*		Mother's Occupation*
Guardian Name*		Guardian Address*
Date of Birth*	(dd/mm/yyyy)	Place of Birth*
Email		Mobile*
Category*	Select Category OBC SC ST UR	Gender*	Select Gender Female Male Transgender
Nationality*	Select Nationality Indian Other	Whether domicile of Madhya Pradesh* Yes No
Medium*	Select Medium English Hindi Urdu	Sub Category  Minority Handicapped JK Migrants JK Residents Freedom Fighter
Phone

Permanent Address Address* State* Select Permanent State ANDAMAN AND NICOBAR ISLANDS ANDHRA PRADESH ARUNACHAL PRADESH ASSAM BIHAR CHANDIGARH CHHATTISGARH DADRA AND NAGAR HAVELI DAMAN AND DIU DELHI GOA GUJARAT HARYANA HIMACHAL PRADESH JAMMU & KASHMIR JHARKHAND KARNATAKA KERALA LAKSHADWEEP MADHYA PRADESH MAHARASHTRA MANIPUR MEGHALAYA MIZORAM NAGALAND ORISSA PONDICHERRY PUNJAB RAJASTHAN SIKKIM TAMIL NADU TELANGANA TRIPURA UTTAR PRADESH UTTARAKHAND WEST BENGAL Copy To Correspondence Address

Correspondence Address Address State Select Correspondence State ANDAMAN AND NICOBAR ISLANDS ANDHRA PRADESH ARUNACHAL PRADESH ASSAM BIHAR CHANDIGARH CHHATTISGARH DADRA AND NAGAR HAVELI DAMAN AND DIU DELHI GOA GUJARAT HARYANA HIMACHAL PRADESH JAMMU & KASHMIR JHARKHAND KARNATAKA KERALA LAKSHADWEEP MADHYA PRADESH MAHARASHTRA MANIPUR MEGHALAYA MIZORAM NAGALAND ORISSA PONDICHERRY PUNJAB RAJASTHAN SIKKIM TAMIL NADU TELANGANA TRIPURA UTTAR PRADESH UTTARAKHAND WEST BENGAL

Particulars of the qualifying examination

Exam Passed* Select University/Board* Select Passing Year* Select 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Percentage*  . %

Is there any gap between studies  Specify the reason*

Other Details
Whether applied for admission to any other course of this university:* Yes No	Course Name*
Whether the applicant is in service:* Yes No	Details*
Whether the applicant's parents are working in this university:* Yes No	Details*
Extra Curricular Activities and Other Certificates (If any)

Other Certificates
240 hrs participation in NSS activities at University level or B/C Certificate	NCC "C" Certificate	Cultural activities at Inter-University level/National level	Sports activities at Inter-University level/National level
Yes No	YesNo	YesNo	YesNo

Enclosures (To be submit in Hard copy in the department)*
Proof for DOB	Marksheet	Migration certificate	Gap Certificate	Caste Certificate	Sub Category Certificate
Required Eligibility Document

Upload Photo with Signature*
Upload Image
Declaration*
I declare that the information given above is correct. I have read the admission rules prescribed by the University and shall abide by them and by all the other rules of the University. Further, I am not pursuing any course from BARKATULLAH University or any other University, either regularly or part time or through Distance mode, fetching me any degree. If I do not submit the required caste certificate/ other certificate/ relaxation at the time of admission for getting weightage and if I do not provide the correct information in required column then I will have no objection if I am considered as a general candidate for admission.
सूचना: ऑनलाइन फॉर्म भरने एवं शुल्क भुगतान करने की सुविधा सीधे छात्रों को उपलब्ध कराई गई है। अतः छात्र स्वयं फॉर्म भरें एवं शुल्क का भुगतान करें। किसी अन्य व्यक्ति या इंटरनेट कैफे से किये गए भुगतान हेतु छात्र स्वयं जिम्मेदार होंगे।