S.M.S GOVT.
MODEL SCIENCE
COLLEGE, GWALIOR
JIWAJI UNIVERSITY
NATIONAL SERVICE SCHEME
ENROLLMENT FORM FOR SESSION 2024-25
1. Name -__________________________________ Passport
2. Father's Name-_________________________ Size recent
3. Father'sOccupation-___________________ photo
4 Mother's Name-________________________
5. Course- ________________________________
6. Date of Birth -__________________________
7. Category(S.C/S.T/O.B.C/ U.R)-__________
8. Blood Group-________
9. Full Address-
__________________________________________________________________________________
______________________________________Pin Code-______________________
10. Contact Number-______________________
11. Email Id-______________________________________
12. Please mark below if you are interested in any of the following activity:-
S.No Activity Interested ( Yes/No) Yet participated or not
1. Sports
2. Yoga
3. Drawing
4. Song
5. Dance
6. Writing
7. Debate/Speech
I _________________ here by agree to obey all the rules and regulations of National
Service Scheme (NSS) and agree to work within the framework of NSS. I state
that all the information furnished by me, are true and correct.
I am aware of NSS work responsibilities and agree to carry out necessary actions.
Dr. A.K Baraiya
Student's sign
(NSS Officer)