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    (For Original Certificate of UG/PG Degree/Diploma Programme) (To Be Filled in by The Applicant)

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    bishal
    This document is an application form for students of Tezpur University to request their original certificate of completion for an undergraduate or postgraduate degree or diploma program. The application collects information such as the student's name, program of study, enrollment number, year of passing, semester examination details including credits completed and grades obtained. The head of the student's department must recommend approval. If approved, the application is processed by the Controller of Examinations and Registrar, and the certificate is signed by the Vice Chancellor. The student can choose to receive the certificate at convocation, by post, or in person.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    (For Original Certificate of UG/PG Degree/Diploma Programme) (To Be Filled in by The Applicant)

    Uploaded by

    bishal
    60 views2 pages
    This document is an application form for students of Tezpur University to request their original certificate of completion for an undergraduate or postgraduate degree or diploma program. The application collects information such as the student's name, program of study, enrollment number, year of passing, semester examination details including credits completed and grades obtained. The head of the student's department must recommend approval. If approved, the application is processed by the Controller of Examinations and Registrar, and the certificate is signed by the Vice Chancellor. The student can choose to receive the certificate at convocation, by post, or in person.

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    This document is an application form for students of Tezpur University to request their original certificate of completion for an undergraduate or postgraduate degree or diploma program. The application collects information such as the student's name, program of study, enrollment number, year of passing, semester examination details including credits completed and grades obtained. The head of the student's department must recommend approval. If approved, the application is processed by the Controller of Examinations and Registrar, and the certificate is signed by the Vice Chancellor. The student can choose to receive the certificate at convocation, by post, or in person.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    60 views2 pages

    (For Original Certificate of UG/PG Degree/Diploma Programme) (To Be Filled in by The Applicant)

    Uploaded by

    bishal
    This document is an application form for students of Tezpur University to request their original certificate of completion for an undergraduate or postgraduate degree or diploma program. The application collects information such as the student's name, program of study, enrollment number, year of passing, semester examination details including credits completed and grades obtained. The head of the student's department must recommend approval. If approved, the application is processed by the Controller of Examinations and Registrar, and the certificate is signed by the Vice Chancellor. The student can choose to receive the certificate at convocation, by post, or in person.

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    Application No

    TEZPUR UNIVERSITY
    NAPAAM:: TEZPUR-784 028::ASSAM

    APPLICATION FORM
    (For Original Certificate of UG/PG Degree/Diploma programme)
    (to be filled in by the applicant)

    1. Name in full (block letters in English and Hindi): ….……………….………………………………………………………………..…………


    ….……………….………………………………………………………………..…………
    2. Sex (Male or Female) ….……………….………………………………………………………………..…………
    3. Home Address: ….……………….………………………………………………………………..…………
    ….……………….………………………………………………………………..…………
    4. Address for correspondence: ….……………….………………………………………………………………..…………
    ….……………….………………………………………………………………..…………
    ….……………….………………………………………………………………..…………
    Email: ……………………………………..… Phone No. ………………………….
    5. Programme of study completed: ….……………….………………………………………………………………..…………
    6. Enrolment No.: ….……………….………………………………………………………………..…………
    7. Registration No. with year, if any: ….……………….………………………………………………………………..…………
    8. Year of passing ….……………….………………………………………………………………..…………
    9. Details of previous semester examinations
    Sem type Year of Credit Semester Year of Credit
    Sem CGPA Semester CGPA
    (Autumn/Spring) passing completed (Autumn/Spring) passing completed
    1st 6th
    2nd 7th
    3rd 8th
    4th 9th
    5th 10th

    10. Total credit completed:


    11. Whether awarded any F Grades(s) in any previous examination: Yes/ No
    If yes i. In which course(s): Course Code ……………..………. Course Title ………………………...………………………… …………………..
    ii. In which semester these grades are converted to the higher grades: ……………….………………………………………………
    iii. Grade awarded after conversion ………………………………………………………………………...…………………………………………
    12. Whether put on academic probation: Yes/No
    If yes i. In which course(s): Course Code ………………..…….. Course Title ………………………………...………………………………………..
    ii. When did you clear the academic probation: ………………………………………………………..…………………………………………..
    iii. Grade awarded after clearance of academic probation: …………………………………………………………………………………….
    13. Mode of receiving certificate
    (please tick √) At convocation By post In person

    I, ________________________________________________________hereby declare that the above particulars are true to the best of my
    knowledge and belief. If found otherwise, I shall be liable to any action.

    Date: Full signature of the candidate


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    RECOMMENDATION OF THE HEAD OF THE DEPARTMENT/ CENTRE

    Certified that Mr. /Ms. ..……………………………………………………………………………..…………. with Enrolment No. ………………………


    was a student of the Dept. / Centre and passed …...…….. Semester End Examination with CGPA ………….. and completed the
    credits requirements (Credit required …………………….. for degree/ diploma/ certificate

    Certificate may be issued to Mr. / Ms. …………………………………………………………………………………………………………………………...

    Head, Dept. / Centre …………………………………………………………….…………………

    For office use only

    Convocation No: Convocation Date: Certificate No:

    Prepared by Verified by Certificate signed

    Dealing Official Controller of Examinations/DR (Academic) Registrar Vice Chancellor

    _____________________________________________________________________________________________________________________________________________
    Encl:
    1. Two copies of recent passport size colour photograph (2.50 cm X3.00 cm)
    2. Photocopy of Provisional certificate or grade cards
    3. Self addressed envelope of A4 size with postal stamp of Rs.80/- only in case the candidate desires to
    receive the certificate by post.
    _____________________________________________________________________________________________________________________________________________

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