SRIMANTA SANKARADEVA UNIVERSITY OF HEALTH SCIENCES
NARAKASUR HILLTOP, BHANGAGARH, GUWAHATI-32, ASSAM, INDIA
Application for Eligibility for Registration of students Migrating from other University/Board/Council
1. Name of the Student (in block letters) : …..............................................................................................................................
2. Father's name in full (in block letters) : …..............................................................................................................................
3. Mother’s name in full (in block letters) : …..............................................................................................................................
4. Date of Birth : …....................................................... Nationality : .................................................
5. Sex : ……………………………………… Mobile No. …………………………….….
6. Home Address in full : …..............................................................................................................................
…..............................................................................................................................
7. Details of Examinations passed:
Examination passed Name of University/ Year of Exam. Division/ Name of School/ College
Board/Council passing Roll No. Class
H.S.L.C.
H.S.S.L.C/Equivalent
Examination
MBBS/BDS/BAMS/
BHMS/BSc (Nursing)
MD/MS/MDS/MD
(Ayur)/MSc (Nursing)
Diploma (Specify)
Others
8. Name of the University/ Board/Council from which migrated :…………………………………..............................................
9. Cause of migration to this University :………………………………………………................................................................
10. Particulars of Course to which admitted :
Course Class/ Roll No. Academic Date of Name of College in Remarks
Semester Session Admission which admitted
I declare that the particulars stated above are true to the best of my knowledge and belief.
If found otherwise, I shall be liable to action.
Date..................................... Full Signature of the Student
RECOMMENDATION OF THE PRINCIPAL/HEAD OF INSTITUTION
Shri/ Smti …………………………......... migrating from .........................................University/Board/Council satisfied
all the requirements for admission to the ……………………. year class/semester of the ....................................... course as per
regulation in the academic session ......................................... Accordingly, he/she has been admitted to the College on
… ..................................................... after verification of all documents.
He/she may be granted Eligibility for Registration for the purpose of enrolment as a student of Srimanta Sankaradeva
University of Health Sciences.
Memo No. ………………… Signature of the Principal/Head of Institution
Date …................................ with Office Seal
Particulars verified and found correct. Eligibility for Registration may/may not be allowed.
Dealing Asstt. Registrar
INSTRUCTIONS
Copies to be enclosed:
1. Migration Certificate (in original). (The candidate should keep a photostat copy of Migration
Certificate for personal record)
2. Photocopy of Mark sheet of the last Examination (to be attested by the Principal/Vice Principal or
Head of a Teaching Deptt. of the College/Institution where admitted).
