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O F F I C E U S E

Batch

Student’s Name

Department

SHANTO-MARIAM UNIVERSITY OF CREATIVE TECHNOLOGY

Admission OfficeHouse # 01, Road # 14, Sector # 13Uttara, Dhaka - 1230Phone: 8918932, 8952610, 8958048, 7912713 - 14Fax: +88-02-8915308email: smuctbd@yahoo.com, Web: www.smuct.edu.bd

Application Form for Provisional Admission

Student ID No

Name of Examination

SSC/'O' Level/Equivalent

HSC/'A' Level/Equivalent

Graduation/Equivalent

Group/ Subject Board/University Division/ GPAYear of Passing

EDUCATIONAL QUALIFICATION

Name of the Programme :

Academic Year : Semester :

Department :

Winter Summer

STUDY PLAN

Nationality :

National ID No. (if any) : Passport No. (if any) :

Religion :

Date of Birth (dd/mm/yy) : Male Female

Permanent Address :

Single Married

First Name: Last Name :

Nick Name : Phone No.: e-mail:

Present Address :

Place & Country of Birth :

PERSONAL INFORMATION

Father's Name :

Occupation :

Occupation :Mother's Name :

Phone No.:

Designation:

Phone No.:

Total Family Members: Sister: Brother: Designation:

PARENTS & FAMILY INFORMATION

Is any sibling currently studying in SMUCT? Please specify -

Is father/mother a freedom �ghter? If so, please attach attested copy of relevant certi�cate.

Shanto-Mariam University of Creative Technology (SMUCT) is committed to the principles of equal opportunity and is open to all students with required academic quali�cations. It does not discriminate between age, race, sex, religion, nationality and social group.

At �rst please read the entire forms properly and type or use capital letters. Complete the form carefully and do not leave any point unanswered.

Others

ANY SPECIFICATION

EXTRA CURRICULAR ACTIVITIES1. 2. 3.

Handicap Tribal Others

Name :

Occupation: Designation:

Employer’s Name:

Address :

Relationship :

Telephone Number :Cell No.:

e-mail:

Signature of the Guardian

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PARTICULARS OF LOCAL GUARDIAN

Signature of the ApplicantDate:

UNDERTAKING

I ................................................................................................................ do hereby declare that,

if admitted into SMUCT, I shall abide by the rules and regulations of the university and the SMUCT students code of conduct.

manufacture, distribution, possession and consumption of tobacco products, alcohol, drugs and controller (illegal) substances at SMUCT premises are strictly prohibited and that I may be expelled for violating the prohibition or for abetting violations.

all the information furnished above are true. I shall be liable for any measure taken against me for violation of any such rules and regulations of the university.

a.

b.

c.

A completed application form;All o�cial transcirpts, certi�cate, testimonial.National ID/Photocopy of Passport/Birth Certi�cate.Passport size colour photograps: 6 copies of applicants, 1 copy of local guardian, 1 copy each of father/mother.Job experience certi�cate (if any):

INSTRUCTIONS

Applications will not be processed unless the following documents are received by the o�ce:

N. B : Original transcripts & certi�cates must be produced at the time of admission for veri�cation.

1.2.3.4.

5.

ALWAYS CARRY YOUR ID CARD DURING THE UNIVERSITY HOURS

FOR OFFICIAL USE ONLY

Name:

Passport SizePhotograph

Father’s Name : Telephone No.:

SHANTO-MARIAM UNIVERSITY OF CREATIVE TECHNOLOGYHouse # 01, Road # 14, Sector # 13, Uttara, Dhaka - 1230

Phone: 8918932, 8952610, 8919366, 01711433491

has been provisionally admitted into Shanto-Mariam University of Creative Technology in the following study plan:

Name of the Programme : Academic Year :

O�ce Seal: Date: Authorized Signature

ID No. : Department :

Winter Summer

PROVISIONAL ADMISSION CARD

Credit Transfer from

Accepted Credit:

May be admitted provisionally

Registrar, SMUCTDate & Seal

Transcript: SSC HSC GraduationCerti�cate: SSC HSC GraduationTestimonial: SSC HSC GraduationOthers: National ID Photocopy of Passport Birth certi�cate;

Papers submitted

If credit transfer, Please attached approval of equivalence committee

Comments from Admission O�cer (If any)

Name of the Admission O�cer:SignatureDate:

Applicant’s Name:

Programme: Batch:

Department: ID/Registration No.