HOSTEL
ADMISSION FORM
Session 2011-2012
The Directror,
South Delhi Polytechnic for Women,
New Delhi
I, the undersigned hereby apply for Admission to the Polytechnic Hostel, subject
to all its Rule and Regulations that may be
applicable to me, from time to time. (The course in which I have been admitted, is .....................................................................)
1. Name(In block letters)..................................................................Marital Status - Single/Married/ Widow/ Separated
2. Mother’s name ............................................................................Occupation ..................................................................
3. Father's Name.............................................................................Occupation
..................................................................
(If business give details)
......................................................................................................................................................
4. Guardian’s Name
.......................................................................Occupation
..................................................................
(If any )
5. Local Guardian's Name....................................................................................................................................................
6. Local Guardian's Address ........................................................................................... Phone: ...................................................................
7. Emergency Contact Number(along with Name)......................................................................................................................................
8. Deit: Vegetarian/ Non-Vegetarian / Egg or Ovo - Vegetarian(Circle one choice , only)
I hereby certify that I have read all the Rules and Regulations of the Polytechnic Hostel, I shall abide by all of them.
I certify that my daughter / Ward will pay the full Hostel Dues, by the due date. She Shall have to abide
by all the Rules and Regulations of the Polytechnic Hostel that may be in force , from time to time. I realise that she may be asked to leave ,in case of repeated disobedience or willful neglect of rules and regulations. I also relise that this has no bearing upon the Hostel Fees.
Signature of Parent/Guardian Signature of Applicant
Date:
UNDERTAKING
This is to affirm that I have read and understood the Rules and Regulations of the Polytechnic Hostel , particularly regarding those going to the Market / Movies / Local Guardian's or meeting visitors. I hereby affirm that she shall abide by them. I also understand that all amounts and charges levied, including that of Hostel fees shall not be refunded, by the Polytechnic. This is regardless of whether I join / do not join /continue / discontinue /or be asked to discontinue, during the Session.
Signature of Parents
/ Guardian Signature
of Applicant
Date:
Date:
Page 2