SOUTH DELHI POLYTECHNIC FOR WOMEN
                                                    HOSTEL ADMISSION FORM

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.

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 in Delhi....................................................................................................................................................

6. Address ........................................................................................... Phone: ...................................................................

7. Local Guardian in Delhi.......................................................................................................................................................

8. Address ............................................................................................Phone( Mobile): .......................................................

9. Whom to contact in an Emergency......................................................................................................................................

10. Course in Which Admission is sought................................................................................................................................

11. Vegetarian/ Non-Vegetarian,(Vegetarian with Eggs)

I hereby certify that I have read all the Rules and Regulations about the Hostel, particularly those regarding going to the Market, Movies, Local Guardians place or seeing Visitors. I shall abide by all of them.


                                                                                                                                                         Signature of Applicant
I certify that my Ward will pay the full Hostel Dues in advance. She will abide by the Rules and Regulations of the Polytechnic
Hostel that may be in force from time to time.

Signature of Applicant                                                                                                                 Signature of Parent/Guardian

Date:

UNDERTAKING

This is to affirm that I have read and understood the Rules and Regulations of the Polytechnic and I shall abide by them. I also understand that all amounts including Hostel Charges shall not be refunded to me by the Polytechnic. This is regardless of whether I join or do not join the Hostel after seeking admission or discontinue during the Term.


Signature of Parents                                                                                                                           Signature of Applicant

Date:                                                                                                                                                 Date:

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