8/12/2019 10022014 b

1/5

UNIVERSITY OF AGRICULTURAL SCIENCES, DHARWADAPPLICATION FOR CONVOCATION

Sl. No.__________

IN PERSON

The filled in application should be sent to the REGISTRAR, UNIVERSITY OFAGRICULTURAL SCIENCES, DHARWAD 580 005so as to reach him not later thanthe last date prescribed.

1. Name of candidate & father in full (INBLOCK LETTERS) as in a) II PUC Marks Card for UG degreeb) UG degree certificate for Masters

degreec) Masters degree certificate for Ph.D.

degree(if the name has been subsequentlychanged & the change has beenapproved by the University, both namesshould be given along with the

University order number and date)2. CsyAi g v vAzAi t g

(Pqz gAiP) -

C)vP zU- .Ai. nPlz

EgAv.)vPvg zU - vP z

CAPnAigAv.

P).JZ.r. zU - vPvg z

CAPnAigAv.

( zAiz CzAiAU MAz

j zuAiiVz z gv zuAiiz gU zAiz

Dz AS v APUAU

P)

WnPv it v Pq vEAV Uvz. CsyU v

U v vAzAi g Pqz V

gAiP.

3. Sex

4. Postal address for communication

(IN BLOCK LETTERS)

Mobile Phone No.: _______________________

5. Details of the Degree programme completed:

Degree programme (Mark the concerned one &strike off the rest)

Yearand

month

ID No. Final CGPA/OGPA

B.Sc(Agri)/B.Sc(For)/B.Sc.(Hort)/

B.Sc.(Ag.Maco)

B.H.Sc.

Contd..2

8/12/2019 10022014 b

2/5

-2-

M.Sc.(Agri) Subject:

M.Sc. Subject:

M.Sc.(Hort) Subject:

M.Sc.(Forestry) Subject:

M.H.Sc. Subject:

M.A.B.M / M.B.A(Agribusiness)Ph.D. Subject:

6. Name of the college wherein the abovedegree programme was completed.

7. Whether the prescribed fee of Rs.900/-for UG, Rs.2500/- for Masters degree& Rs.3750/- for Ph.D in the form of DDdrawn in favour of Comptroller, UAS,Dharwad is enclosed herewith.

If yes,

DD No :_______________

Value : _______________

Date : _______________

Degree : _______________

* Note: Incomplete applications are liable to be rejected.

Date: ________________ Signature of the Applicant

INSTRUCTION:

1. Please fillup all the columns clearly.

2. Please enclose XEROX COPIES OF PUC MARKS CARD, PDC & CGPA/OGPA CARDof the degree for which you have applied.

3. Please enclose a self addressed envelope duly stamped to facilitate acknowledgementof your application & communication of the exact date, time and place of theconvocation.

4. The date of convocation will be notified later.

5. DD should be drawn in favour of The Comptroller, UAS, Dharwad.

6. Money orders and cheques will not be accepted.

7. Application not accompanied with filled in proforma for Best Teacher shall be rejected.

DECLARATION TO BE SIGNED BY CANDIDATES RECEIVING DEGREEIN PERSON

I hereby solemnly declare and promise that if admitted to the degree of___________________ for which I have been duly recommended I will, in my daily life andconversation, conduct myself as befits a member of this University that I will do the utmostof my capacity and opportunity, support the cause of morality and sound learning and that,as far as it lied in me, I will follow for the Agricultural prosperity of the country.

Signature

****

8/12/2019 10022014 b

3/5

UNIVERSITY OF AGRICULTURAL SCIENCES, DHARWADAPPLICATION FOR CONVOCATION

Sl. No.___________

IN ABSENTIA

The filled in application should be sent to the REGISTRAR, UNIVERSITY OFAGRICULTURAL SCIENCES, DHARWAD 580 005so as to reach him not later thanthe last date prescribed.

1. Name of candidate & father in full (IN

BLOCK LETTERS) as in d) II PUC Marks Card for UG

degreee) UG degree certificate for Masters

degreef) Masters degree certificate for

Ph.D. degree(if the name has been subsequentlychanged & the change has beenapproved by the University, bothnames should be given along with the

University order number and date)2. CsyAi g v vAzAi t g

(Pqz gAiP) -

C)vP zU- .Ai. nPlz

EgAv.

)vPvg zU - vP z

CAPnAigAv.

P).JZ.r. zU - vPvg z

CAPnAigAv.

( zAiz CzAiAU MAz

j zuAiiVz zg v zuAiiz gUzAiz Dz AS v

APUAU P)

WnPv it v Pq

v EAV Uvz. CsyU

v U v vAzAi g Pqz

V gAiP.

3. Sex4. Postal address for communication

(IN BLOCK LETTERS)

Mobile Phone No.: ______________________

5. Details of the Degree programme completed:

Degree programme (Mark the concerned one& strike off the rest)

Year andmonth

ID No. Final CGPAOGPA

B.V.Sc. & A.H.

B.Sc(Agri)/B.Sc(For)/B.Sc.(Hort)/B.Sc.(Ag.Maco)/B.Tech(Ag.Engg)

B.H.Sc.

Contd..2.

8/12/2019 10022014 b

4/5

-2-M.Sc.(Agri) Subject:

M.Sc. Subject:

M.Sc.(Hort) Subject:

M.Sc.(Forestry) Subject:

M.H.Sc. Subject:

M.V.Sc. Subject:

M.A.B.M / M.B.A(Agribusiness)

M.Tech(Ag.Engg) Subject:

Ph.D. Subject:

6. Name of the college wherein the abovedegree programme was completed.

7. Whether the prescribed fee ofRs.1200/- for UG, Rs.3125/- forMasters degree & Rs.4375/- for Ph.D

in the form of DD drawn in favour ofComptroller, UAS, Dharwad is enclosedherewith.

If yes,

DD No :___________________

Value : ___________________Date : ___________________

Degree : ___________________

* Note: Incomplete applications are liable to be rejected.

Date: ________________ Signature of the applicant

INSTRUCTION:

1. Please fillup all the columns clearly.

2. Please enclose XEROX COPIES OF PUC MARKS CARD, PDC & CGPA/OGPA CARDofthe degree for which you have applied.

3. Please enclose a self addressed envelope duly stamped to facilitate acknowledgement ofyour application & communication of the exact date, time and place of the convocation.

4. The date of convocation will be notified later.

5. DD should be drawn in favour of Comptroller, UAS, Dharwad.

6. Money orders and cheques will not be accepted.

7. Application not accompanied with filled in proforma for Best Teacher shall be rejected.

DECLARATION TO BE SIGNED BY CANDIDATES RECEIVING DEGREE

IN ABSENTIA

I hereby solemnly declare and promise that if admitted to the degree of___________________ for which I have been duly recommended I will, in my daily life andconversation, conduct myself as befits a member of this University that I will do the utmostof my capacity and opportunity, support the cause of morality and sound learning and that,as far as it lied in me, I will follow for the Agricultural prosperity of the country.

Signature

****

8/12/2019 10022014 b

5/5

Serial No.

UNIVERSITY OF AGRICULTURAL SCIENCES, DHARWAD

Format for Best Teacher Award

(To be filled by the candidate and compulsorily submittedalong with convocation application form )

College : _______________________Degree obtained :_________________________

I. Name three Scientists/Teachers who in your opinion did excellent teaching in yourcollege.

Name of the Scientist / Teacher Course Taught

1. ____________________________________ ________________________________

2. ____________________________________ ________________________________

3. ____________________________________ ________________________________

II. List the weaknesses of teaching programme in the college from where you graduated.

II. List the strengths of teaching programme in the college from where you graduated.

Signature of Candidate

Name: