Name: Mr./Ms.

Date of Birth: Sex: Male/Female

GEN SC ST OBC BC
Category Religion:…………...


Father’s Name:

Occupation :…………………………………. Designation:…………………………...............



Office Tel. No. Mobile No.



Pin Tel

Mailing Address:

Pin Tel
Permanent
Address:

Local Guardian’s Name (For the candidates Outside from Meerut)

Pin Tel
Address of the Local Guardian’s (Submit the Photograph of L.G)

Qualifying Entrance Test (If appeared in UPTU/AIEEE/MAT/CAT)
Entrance Test Roll No. Marks Rank (Gen.) Rank (Cat.)

ACADEMIC QUALIFICATION:
Exam. Passed School/College Board/Univ. Passing Year Subject Max Marks Marks Obtained Percentage
Of Marks
10th
12th Physics (P)
Chemistry (C)
Mathematics (M)
TOTAL PCM
Biology/CS/BT
English
Hindi
Others
Grand Total
Other’s
Graduation/
Diploma


Grand Total
CS IT ECE EN/EEE

Choice of Branch :
(Please indicate your preference by. 1,2,3,4)

Hostel Accommodation: Required/Not Required

DECLARATION BY APPLICANT
I, …………………………………….……………….……, declare that all the above mentioned details are true to the best of my knowledge and belief, if anything found wrong in future the college authority has all rights to cancel my admission.

I understood all the norms for the admission to B.Tech course & also fulfill all the eligibility requirements for admission to this course. I understand that the decision to offer me a place rests with the college. I hold myself responsible for the dues & and prompt of fees. I have noted that the fees paid are not refundable at any circumstances.

I promise to college authority that I will always follow the Rules & Regulations of College, Hostel & Mess during my study & never be involved in any type of ragging. If any thing goes wrong from my side, Institute authority has all rights to take disciplinary action against me.

Date:…………………………………… Signature of the Candidate

I, …………………………………………………………….., fully endorse the declaration made above by the candidates, beside I undertake the guarantee for his conduct & behavior during the tenure of his/her study in the college, I also hereby declare that we understood all the rules & regulations of the college and we promise to abide by them. If my ward violets the rules & regulations of the college & Hostel (including any addition/deletion or modification in future), my ward shall render for disciplinary action including expulsion from the institute and or any other punishment given by authority.

Date:…………………………………… Signature of the Parent/Guardian

CHECK LIST

Following attested copy of the documents must be enclosed, failing the application shall be treated as incomplete & liable to be rejected.

1. Date of Birth Certificate (Xth class passing certificate)
2. Marksheet of class 10th
3. Marksheet of class 12th
4. Marksheet of any other eligible qualification (if any)
5. Character certificate from the Head of the institution last attended
6. Migration Certificate issued by Board/University
7. Recent passport size photograph (five)