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NAGALAND

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Jfocfl@ 3tfrortfo W qrco}~ fiocJ& ffocJh d)@tl) (A Central
University
established by an Act of Parliament No.35 of 1989)1tgg·"lJo@tl:
"ffglfo"Jlfo't I Headq uarter s: Lumami
************************************************************
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APPLICATION FORM FOR REGISTRATION OF STUDENTS
NAGALAND CONSERVATORY OF MUSIC COLLEGE/DEPARTMENT
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1. Official Name in Full (In Block Letters)
: R. LALMALSAWMHLUA
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2. Sex (Male/Female/Others): MALE Categ ory_~ S......
T_ _ _ _ _ _(GEN/OBC/EWS/SC/ST)
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3. Date of Birth (As per HSLC/Matric Record) :__1...;:. 0;;..:; /1=2; ;..:;/1 """9= 90=-- ------ ------ ---
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4. Father's Name (In Block Letters)
R. LALRINTLUANGA
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5. Mother's Name (In Block Letters)
R. LALBIAKLIANI
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6. Home Address in Full
VC-36, V AlV AKAWN, AIZAWL, MJZO RAM
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7. Previous Records :
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(a) Boards/CounciVUniversity from which Passed last examination
: . .;:.Nl~O..;a:;S_ _ _ _ _ _ _ _ __
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(b) School/College/Department last studied : NATIONAL INSTIT
UTE OF OPEN SCHOOLING
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(c) Name of Last examination passed (With Roll no. & Year) :SENIO
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R SECONDARY SCHOOL
9231430061 7(2014)
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(d) Division/Class/Rank secured in last examination: __,; :.T=
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8. Present Records :
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(a) Date of Admission (1 st Year/I st Semester) : -=1=5-'h-=-JU==L"""'Y-'2=0=2'--'-4_ _ _ _ _ _ _ _ _ _ _ __
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(b) Class in which studying as on the date of application :_1.:...st--=-S
E=ME ==S"- "'T-= E=R= ------- ----
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(c) Whether as Regular/Private candidate __.:.; RE=G =-=U =-=L =AR- =----- ---'~- ------ -
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(d) College/Department Roll Number
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9. Contact Number +918119967261
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 10. Fee Paid: NU Challan/DD No. : .....
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Signature of the Head of Institution/Departm

ent
(With Seal)
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"ID ~~ O~ ~W Uo TR
~~

N.B. I. This application should be supported

by One Xerox copy of each of the following
Gazetted officer : documents and attested by a
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(a) Admit card & Mark Sheet of HSLC or
equivalent examination.
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(b) Mark Sheet of the last examination
passed.
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(c) Certificate of conduct from the Principa
l/Headmaster of the institution last atten
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(d) Migration Certificate in original alon
g with Eligibility Certificate in case of stud
University. ents coming from outside Nagaland
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2. In case of regular stud ents, this form should be fotwarded by the FJ U1loTOT-'QTI
particulars filled by the student. The nam Principal after carefully verifying the nam
e mentioned here should exactly tally with e and other
produced by him/her at time of admissio that contained in the certificate(s)
n.
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3. In case of a private candidate the form ffli ltfo ~I
should be countersigned by the Principal
appear fur the University Examination. of the college from where he/she will
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4. Fees should be paid only by NU chal
lan/SBI I-collect or Banlc Draft S.B.I. in
~go ~fol tfgl@oR ~ <@ ~~ t{o favour of Registrar, Nagaland Universit
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Please Indicate you r category ofApp

lication (Fick one only)
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UNDER GRADUATE
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D (t 200/-) POST-GRADUATE/B.ED/M.PHILIPH.D
{ (~ 400/-)
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5. Registration Card will be issued to the --
Principal concerned.
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