JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Dean Student Welfare National Service Scheme (U.T.D) Kurukshetra University, Kurukshetra
(established by the state Legislature Act XII of 1956) (A+ Grade, N.A.A.C Accredited)
Sign in to Google
to save your progress.
Learn more
National Service Scheme (U.T.D) - Registration Form
Your answer
Session :
Choose
2018-19
2019-20
1. Name of the Student Volunteer(in block capital letters)
Your answer
2. Father's name
Your answer
2 (a) Father's occupation
Government employee
Business
Farmer
Other
Clear selection
3. Mother's Name
Your answer
3(a) Mother's occupation
Government employee
Business
Farmer
House wife
other
Clear selection
4. Date of Birth
MM
/
DD
/
YYYY
5. Gender
Male
Female
Other
Clear selection
6. Class
Your answer
6 (a) Roll No.
Your answer
7. Department / Institute Name
Your answer
8. Mobile No.
Your answer
9. Email id
Your answer
10. Present Address
Your answer
11. Permanent Address
Your answer
12. Category
General
SC
BC(A)
BC(B)
PH
ESM
Any other
13. Blood Group
Your answer
14 (i). Educational Qualification - Xth (10th) Name of the Institute attended
Your answer
14 (ii). Educational Qualification - Xth (10th) Board / University
Haryana Board
C.B.S.E
other
Clear selection
14 (iii). Educational Qualification - Xth (10th) year of passing
Your answer
14 (iv). Educational Qualification - Xth (10th) Division
I st
II nd
III rd
Clear selection
14 (i). Educational Qualification - XIIth (12th) Name of the Institute attended
Your answer
14 (ii). Educational Qualification - XIIth (12th) Board / University
Haryana Board
C.B.S.E
other
Clear selection
14 (iii). Educational Qualification - XIIth (12th) year of passing
Your answer
14 (vi). Educational Qualification - XIIth (12th) Division
I st
II nd
III rd
Clear selection
14 (i). Educational Qualification - Graduation Name of the Institute attended
Your answer
14 (ii). Educational Qualification - Graduation Board / University
Your answer
14 (iii). Educational Qualification -Graduation year of passing
Your answer
14 (vi). Educational Qualification - Graduation Division
I st
II nd
III rd
Clear selection
15. Given below are some of the areas/ fields in which social service programme could be organised. please tick ( right) the areas / fields in which you would like to contribute as NSS volunteer: a) Health
Yes
No
Clear selection
b) Development
Yes
No
Clear selection
c) Welfare
Yes
No
Clear selection
d) Environment
Yes
No
Clear selection
e) Education
Yes
No
Clear selection
16. Whether you were NSS volunteer during graduation ? if yes, mention the areas of work and interest:
Yes
No
Clear selection
16. (i) Whether you were NSS volunteer during graduation ? if yes, mention the areas of work and interest:
Your answer
17. (i) Distinction achieved (if any) in Social Service / NSS (including NSS certificate)
Yes
No
Clear selection
17. (ii) Distinction achieved (if any) in Social Service / NSS (including NSS certificate)
Your answer
18. Aadhar Card No.
Your answer
Date
MM
/
DD
/
YYYY
Signature of Applicant
Your answer
Undertaking : I do undertake that I shall abide by all the rules / norms of NSS and devote myself selflessly for fulfilment of assigned undertaken responsibilities and behave in a disciplined and responsible manner.
Yes
No
Clear selection
Name:
Your answer
Father Name
Your answer
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
