PONDICHERRY UNIVERSITY PONDICHERRY
STUDY INDIA PROGRAMME
Name of the candidate: …………..…. …………..……. ……….………
(In Block letters) Last First Middle
Male/ Female: ………
Date of Birth: …………. ………. ………..……
Day Month Year
Place of Birth: ………. ………... ………..
City State Country
Social Security Number: ………
Citizenship: ………..
Email: ………
Permanent Address: ………
………
……….
Zip………
Telephone Number: ……….
Current School Address: ………..
………
……….
Zip………. … Telephone Number: ……….
Affix recent photograph
Parent/ Guardian:
Name: ……….. ……… ………..
Last Middle First
Mailing Address: ………
………
………
Zip……….
Home Phone Number:……… Office Phone: ……….
Email ID: ……….
Contact details in India (if any): ………
………
……….
Telephone Number: ………..
Name of the Department (s) where from the candidate whishes to study:
………
Period of study: One Semester Two Semester 2 year full time study Semester Selection: Even Semester: December/ January to April/ May
Odd Semester: July/ August to November
Others- (If joining/ leaving other than at beginning or end of the semesters indicate the date of commencement/ leaving)
………
Course Selections: 1……….
2………...
3……….
4……….
5……….
6……….
7 ………
8 ………
Anticipated date of arrival in India:
Anticipated date of departure from India:
Health Insurance details (if any):
Passport Details: ……… ………. ……… ………...
Number Date of Issue Place of Issue Date of expiry Accommodation information: On-campus Own Private arrangement (Hotel, apartment, etc) (Fully furnished separate foreign students hostel available on-campus)
Academic Record: (From High school onwards) (Copies of certificates to be enclosed)
Sl.No Courses Studied College University
Year of Passing
Subjects GPA
1
2
3
4
* Selected candidates will be asked to pay a non-refundable fee in favor of the Finance Officer, Pondicherry University. Only after receipt of the fee the admission will be provisionally confirmed. The balance amount will have to be paid on arrival or on mutually agreed terms.
* Please mention what kind of documentations would be required by you for getting visa and permission from your University/ School. Please also mention the deadlines.
DECLARATION BY THE APPLICANT
I hereby declare that all the statements made by me in this application and in the documents submitted in support of my application are true, complete and correct to the best of my knowledge and belief. During my stay in India, I shall abide by the rules and regulations of the Government of India and of Pondicherry University.
Place :
Date : Signature of the applicant
