Form No.
TEZPUR UNIVERSITY
NAPAAM (TEZPUR)
SONITPUR, ASSAM, INDIA
PIN-784028

APPLICATION FORM
FOR PROVISIONAL ADMISSION OF FOREIGN STUDENTS
ACADEMIC SESSION ……………..
Note: Read the guidelines carefully annexed herewith before filling the Application Form

To,
The Dean, Student Welfare
Tezpur University
Napaam,( Tezpur)
Assam, INDIA Pin-784028

Sir/Madam,
I wish to seek admission in Tezpur University and submit the following particulars for consideration:-
1. Name in full (Capital letters)……………………………………………………………………
2. Gender: (Male/Female)……………….. 3. Marital Status: (Married/Unmarried)…………………
4. Date and place of birth…………………………………………………………………………..
5. Nationality …………………………………………………………………………………………….
6. Permanent Address …………………………………………………………………………………..
………………………………………………..E-mail: ………………………………………………
7. Name of father /husband/ guardian ………………………………………Occupation.........…………
8. Permanent address of Father /Husband / Guardian……………………………………………………
……………………………………………………………………………………………………
9. Mother’s name………………………………………………………………………………………...
10. Mother’s occupation & Permanent address…………………………………………………………..
11. Address of contact person in India …………………………………………… ……………………..
…………………………………………………………………………………………. ……………...
Contact phone no.& e-mail (if any) …………………………………………………………………….
12. (a) Programme to which admission is sought( indicate choices in order of preference )
(i) ……………………………………………………………………………………………
(ii) ……………………………………………………………………………………………….
(iii) ……………………………………………………………………………………………….
(b) For admission to Ph.D. Programme
(i) Name of the Department ……………………………………..…………………………..
(ii) Name of the proposed supervisor……………………………………………………
(iiii) Topic for Research ………………………………………………………………………
……………………………………………………………………………………………
(Attach two copies of Research Proposal/Synopsis)
(c) Category of Foreign / NRI students ( Pl. see the Guidelines): …………………………………...
……………………………………………………………………………………………………
(d) Are you presently employed Yes / No
If yes, pl. give complete name and address of your employer……………….………..
………………………………………………………………………………………... …….. ……………………………………. ………………………………………………………… …………………………………………………………
(e) Length of service ( with dates )……………………………………………………………………

13. Educational Qualifications
Examination/
course passed Board/
University Duration of the exam / course passed Year of passing Marks/ Grade Subjects
Studied
Gr./Marks obtained Max
marks

14. Number of years completed in school (at the time of application) …………………………
15. Have you applied for any course/programme of study in India prior to this? Yes / No
If yes, pl. furnish the following information
a. Name of the course/ programme ..................................................................................
b. Name of the Board /University/Institute ……………………………………………..
c. Year of admission ……….. year of completion ……….. other information, if any
……………………………………………………………………………………
16. Language (s) known .....................................................................................................................
17. Proficiency in Spoken English Good/Fair/Poor
18. Passport No…………………………………………………………………………………….
19. Date and place of issue of Passport…………………………………………………………….. 20.Score in English Proficiency Test like TOEFL / ELTIS ……………………………………
21. Details of Visa with date of issue……………………………………………………………….
22. Declaration by the Applicant:
a. The information provided above is true and accurate.
b. All documents attached with this application are authentic.
c. I further affirm that I have not been involved in any malpractice/use of unfair means in any examination given by me and no judicial proceeding is pending against me.
d. I understand that in the event of my not fulfilling the requirements fully or partially, Tezpur University has right to reject/cancel my candidature.
e. I declare that I shall submit myself to the disciplinary jurisdiction of the authorities of the University in the event of violation of discipline rules in the university campus or out side the campus during my stay as student in the university.
f. I shall abide by the Act, Statutes, Ordinances, Rules and Regulations of the university which may be framed or amended from time to time.
23. I have read and understood the guidelines given in Annexure.

Place:………………………. …………………………………
SIGNATURE OF APPLICANT
Date: …………………..
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Note: 1. Enclosures to be submitted alongwith the application:
a. Attested copies of the school and degree certificates
b. Attested copies of mark sheets / grade statements of all examinations.
c. Attested copy of the birth certificate showing date of birth.
2. If the certificates are not in English, certified copies of these certificates must be submitted.
3. The application form should be filled up with English Block letters and incomplete form will be
rejected summarily.
4. The prescribed eligibility fee ( 50 US dollar) must be sent along with the application.

CERTIFICATE TO BE FURNISHED BY THE INDIAN DIPLOMATIC REPRESENTATIVE OR A RESPONSIBLE OFFICIAL OF THE MISNISTRY OF EDUCATION OF APPLICANT’S COUNTRY’S OR AN OFFICIAL OF THE APPLICANT’S COUNTRY ‘S EMBASSY / HIGH COMMISSION IN INDIA

I. Certified that the Board/University from which the applicant has passed the examination is legally constituted and dully recognized.
II. Certified that the entries in the application form particularly about the examination passed, marks/ grades, division obtained, subject studied etc. are correct.

Place……………………….. …………………………..
Signature with
Date……………………….. Designation & Official Seal