REGULAR MODE COURSES APPLICATION

FORM- 2024
APPLICATION NO: MMDU/UG_24/NUR/15153

Campus Details
Faculty Applied For BACHELOR'S PROGRAM
Program Applied For NURSING
Specialization Applied For B.SC. (NURSING)

Personal Details
Name RAJAN Email Address RK8271772@GMAIL.COM
Mobile No. +91-8541044487 Blood Group O+
Date of Birth 09/08/2006 Gender MALE
Marital Status SINGLE Nationality INDIAN
Are You Physically Challenged NO Nature of Deformity
Add Family ID (For Haryana
Percent Of Deformity
Resident Only)
Category OBC State of Domicile BIHAR
District PURBI CHAMPARAN Aadhaar Card No. 683145965439
Country Of Residence Passport Number
Country Place of Issue
Date of Issue Date of Expiry
Proof of Identity AADHAAR CARD

Parents Details:
Father Details Mother Details
Name NAND KISHOR RAUT MAYA
Home Phone 9031599524 9031599524
Mobile Number +91-8541044487 +91-8541044487
Occupation OTHER|NA PRIVATE SECTOR
Designation RAXAUL RAXAUL
Email Address FATHER@GMAIL.COM MOTHER@GMAIL.COM
Annual Income NA 70000

Address Details:
Is Permanent Address Same As Address For Correspondence? YES
Correspondence Permanent
Country Name INDIA INDIA
State Name BIHAR BIHAR
District Name PATNA PATNA
City Name PATNA PATNA
Address Line 1 SUNDERPUR RAXAUL SUNDERPUR RAXAUL
Address Line 2 SUNDERPUR RAXAUL SUNDERPUR RAXAUL
Pincode 845305 845305
Educational Details:

Xth Academic Details

Year of Percentage /
Institute/School name Board / University Score Type
Passing CGPA
PEERY MATRICULATION HIGHER TAMIL NADU BOARD OF
X 2022 PERCENTAGE 72.6
SECONDARY SCHOOL SECONDARY EDUCATION

From Where Class XIIth Passed / Appearing

XIIth State TAMIL NADU XII District KANCHIPURAM

XIIth City KANCHIPURAM

XIIth Academic Details

Year of Percentage /
Institute/School name Board / University Status Score Type
Passing CGPA
TAMIL NADU BOARD OF
PEERY MATRICULATION HIGHER
XII HIGHER SECONDARY PASSED 2024 PERCENTAGE 66.5
SECONDARY SCHOOL
EDUCATION

XII Subject Marks

Name Of Subject Marks Obtained Max Marks Percentage
1 HINDI 85 100 85
2 ENDLISH 77 100 77
3 PHYSICS 45 100 45
4 CHEMISTRY 56 100 56
5 BIOLOGY 64 100 64
6 5 327 500 65.4

From Where Diploma Passed / Appearing

Diploma State Diploma District

Diploma City

Diploma Academic Details

Institute/School Board / Year of Score Max Obtained Percentage /
Status
name University Passing Type Marks Marks CGPA
Diploma

From Where Graduation Passed / Appearing

Graduation Details
State District
city

Graduation Details
Institute University Status Year of Passing
UG

Graduation Marks
TOTAL MARKS MARKS OBTAINED (AGGREGATE) PERCENTAGE
UG

Other Qualification
Institute University Status Year of Passing Score Type Percentage / CGPA
UG

Have You Given Any Entrance Exam? NO

Entrance Test Details:
Exam Name Roll No. Valid up to Score/Percentile Conducted by
GATE
Any Other Test

Do You Have Any Work Experience? NO

Employment Details:
Company Designation From To Total Experience
1
2
3

How Did You Know About Us?

How Did You Know About Us RADIO ADS

Declaration
I declare that entries made by me in this Application Form are true and correct in all respects and in case any entry or information
given by me in this form is found to be false, this shall entail automatic cancellation of my admission besides rendering me liable
to such action as Maharishi Markandeshwar (Deemed to be University), Mullana - Ambala may deem proper. I have noted that my
admission and my continuance on the rolls of MM(DU) are subject to the provisions of MM(DU) and other rules and instructions as
may be applicable from time to time.
I also undertake that I shall abide by the rules of discipline and proper conduct as are applicable from time to time in MM(DU). I
am fully aware of the Regulations of the UGC and other Regulating Bodies and law regarding Ragging as well as the punishment if
found guilty on the account, I am liable to be punished accordingly. I undertake that I shall not indulge in any act of ragging. I also
undertake that I have read and understood the Prospectus 2024-25 issued by the Maharishi Markandeshwar (Deemed to be
University), Mullana - Ambala.
Applicant Name RAJAN
Parent Name NAND KISHOR RAUT

Signature

Date 17/05/2024
 REGULAR MODE COURSES
APPLICATION FORM- 2024
APPLICATION NO: MMDU/UG_24/NUR/15153

Faculty Applied For BACHELOR'S PROGRAM Program Applied For NURSING

Specialization Applied for B.SC. (NURSING)
Name: RAJAN
Father's Name: NAND KISHOR RAUT Mother's Name: MAYA
Address: SUNDERPUR RAXAUL , SUNDERPUR RAXAUL

City: PATNA State: BIHAR PIN: 845305

Contact No’s:
Student: +91-8541044487 Father/Guardian: +91-8541044487 Mother: +91-8541044487

E-Mail: RK8271772@GMAIL.COM Category: SC/BC/ESM/PH/GEN : OBC

DOB: 09/08/2006 Sex(M/F): MALE Nationality: INDIAN

Academic Details
XIIth Diploma Graduation Other
Name of Board / University TAMIL NADU BOARD OF HIGHER SECONDARY EDUCATION
Name of Institute PEERY MATRICULATION HIGHER SECONDARY SCHOOL
Year of Passing 2024
Total Marks 500
Marks Obtained 327
Percentage 65.4

XII Subject Marks

Name Of Subject Marks Obtained Max Marks Percentage
1 HINDI 85 100 85
2 ENDLISH 77 100 77
3 PHYSICS 45 100 45
4 CHEMISTRY 56 100 56
5 BIOLOGY 64 100 64
Total 327 500 65.4

Total Marks: Marks Obtained: Percentage:

Entrance Test Details:

Exam Name Roll No. Valid up to Score/Percentile Conducted by
GATE
Any Other Test

Details of Original Documents/Photocopies to be presented before the Committee for verification: (along with two extra set of
photocopy of that certificates duly attested to be attached with this form.)

10th* P O 10+2* P O Character Certificate* P O Migration* P O

Graduation* P O Family Id(For Haryana Residents only) *

Aadhaar Card No *
683145965439

Document Verified by Verified By REG. Branch Candidate Signature

Seat is allotted in ___________________________________________________________________subject to verification of original documents by

the Maharishi Markandeshwar (Deemed to be University) and deposit of fee on the day of Counseling failing which allotment
of seat will stand cancelled. Admission will be provisional until final registration by the MM(DU).
 REGULAR MODE COURSES
APPLICATION FORM- 2024
APPLICATION NO: MMDU/UG_24/NUR/15153

The Chief Warden,

M.M. (Deemed to be University),
Mullana-Ambala

REQUEST FOR ALLOTMENT OF A SEAT IN HOSTEL

Sir,
Kindly allot me a seat in the hostel for the session ..............., for which I hereby submit my particulars as under:
Hostel Details:
Would You Require Hostel Accommodation :NO Application No. MMDU/UG_24/NUR/15153
Name RAJAN
Mobile No. +91-8541044487 E-mail Address RK8271772@GMAIL.COM
Category OBC Course NURSING
Institute Name Class
Roll No. Admission Rank
Hostel No. Room No.
Session Fee (Due)
Amount (Received)

Parents Details:
Father Details Mother Details
Name NAND KISHOR RAUT MAYA
Mobile No +91-8541044487 +91-8541044487
Email FATHER@GMAIL.COM MOTHER@GMAIL.COM
Occupation OTHER|NA PRIVATE SECTOR
Office Address

Address Details:
Is Permanent Address Same As Address For Correspondence? YES
Correspondence Permanent
Country Name INDIA INDIA
State Name BIHAR BIHAR
District Name PATNA PATNA
City Name PATNA PATNA
Address Line 1 SUNDERPUR RAXAUL SUNDERPUR RAXAUL
Address Line 2 SUNDERPUR RAXAUL SUNDERPUR RAXAUL
Pincode 845305 845305

Declaration by the Applicant

I undertake to abide by the hostel rules and will pay the hostel dues regularly. Further, I have undergone through the hostel rules
given overleaf.
Date:___________ Signature of the Applicant _______________________
Declaration by the Parents/Guardian
I undertake to pay all the dues in respect of my son/daughter/ward within seven days from the date of notification. I, further,
assure that he/she will not indulge in any kind of indiscipline and any act of ragging in the University/Hostel. I have also seen the
hostel rules given overleaf.
Date:___________ Signature of Parents/Guardian _____________________
 Hostel Rules:

1.No student shall keep any unauthorized person in his/her room.

2.In the event of any mischief/foul play or accident etc., the warden will be authorized to break open the room for investigations.

3.Whenever, a student leaves the station or remains outside the hostel for the night, he/she should obtain prior permission of the warden
and enter the same in the register kept in the hostel office.

4.No student is permitted to entertain any student of this college, who stands expelled from the college or the hostel, as guest on any
ground.

5.No female visitor is allowed in boys’ hostels and male visitors in girls’ hostels except in the office with the written permission of the
respective wardens.

6.Students are forbidden to utilize hostel servants for any private work or as private servants.

7.No student will argue abuse or misbehave with the mess contractor/staff. Complaint, if any, should be brought to the notice of the
warden immediately.

8.All the students shall, at all times, conduct themselves in a disciplined manner inside the hostel. They should not do anything which may
disturb others at study or at work in the hostel.

9.The following are strictly forbidden in the hostel:

a.Possession or use of alcoholic beverages.

b.Possession or use of addictive or hallucinogenic drugs.

c.Possession or use of offensive arms or any lethal weapon.

d.Playing cards.

e.Arranging of any private party and cooking private food.

10. The father/mother only are allowed to visit their ward in hostel any time. A relative can meet during day time only if the parents have
supplied the complete information and photo of the concerned person under their signature and authority. The name of such relative
should indicate the exact relationship with the student, if desired by parents to be permitted to see their ward, and should be got approved
from the principal in advance.

11.Parents must provide the address of the relative whom their ward can visit in holidays.

12.The residents in the girls hostel will be treated absent in case they do not mark their evening roll call in time, i.e., up to 07: