APPLICATION FORM SUMMARY -M.E./M.Tech/M.

Pharm 2011-12
(TO BE ATTACHED WITH APPLICATION FORM)

Application No.:_____________________ 1. 2. 3. GATE/GPAT Candidate: Sponsored candidate: Name : Yes Yes No No

4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

Date of Birth : (DD/MM/YYYY): Gender : Discipline Code Male

Female

Discipline Name:____________________________

Qualifying exam passed/appeared code: Category: OPEN Yes SC No ST SEBC In/Ex Serviceman

Physical Disability:

(If yes) ________ % Yes Yes No No

B.E./B. Pharm passed from Gujarat: XII (Science)/Diploma passed from Gujarat: GATE/GPAT marks BE/B. Pharm Final Year % . .

Date : Place: Signature of Candidate For Office Use Only

Name and Signature of First Scrutinizer Remarks:

Name and Signature of Final Scrutinizer

Application No.:_____________

Directorate of Technical Education, Gujarat State, Admission Committee for Professional Courses (ACPC)
(Constituted under Section 4 of the Gujarat Professional Technical Educational Colleges or Institutions (Regulation of Admission and Fixation of Fees) Act., 2007 (Guj.2 of 2008) vide Government Notification, Education Department th No.GH/SH/7/PVS-102003-639-S, dated the 5 May, 2008.)

Application Form M.E./M.Tech/M.Pharm 2011-12

Merit No: GATE/GPAT SPONSERED Name (In block letters) : Mothers Name : Date of Birth: D D M M Y Y Y Y Gender : Discipline Code: Correspondence Address : City : Taluka: District: PIN : Telephone Number: E-mail: Category: OPEN Physical Disability: Yes Discipline Name: Permanent Address : City : Taluka : District: PIN : Mobile Number : SC ST SEBC No (If yes) ________ % Educational Qualifications
Name of Exam. HSC/
Diploma

Qualifying Examination Code NON-GATE /NON GPAT NON- SPONSERED

Affix Recent Passport Size Color Photograph With candidates Signature Across

Male

Female

IN / Ex-Serviceman

Board/University

School/College

Year of Marks Class/ Passing obtained Grade

% / CPI (For CPI give conversion to equivalent %)

Specialization

Sem VII Sem VIII B Pharm (Final Year) Other

B.E./B.Pharm Final Year (VIIth & VIIIth Sem.) Percentage: GATE/GPAT Year of Passing Reg. No. Marks Score Examination paper (subject)

Details of Experience
Sr. Name & Address of Employer/Institutes Designation Type of Experience

(For Sponsored candidates only)

From

Duration Years-months To

Application form Fee Details Name of Bank Panjab National Bank Branch Name Receipt No. and Date Amount(Rs)

DECLARATION OF THE CANDIDATE

I do hereby declare that all the particulars stated in the application are true and correct to the best of my knowledge and belief. I have read the Admission Rules and Information, and I shall abide by all the rules and other terms and conditions for admission. In the event of suppression or distortion of any information provided in my application form, I understand that admission granted by the Admission Committee shall be liable for cancellation. I also understand that the decision of the Admission Committee regarding my admission shall be final and I shall be liable by its decision. Further, if admitted, I promise to abide by the rules and regulations of the Institute as applicable during the course of study. I am also aware that ragging is banned and if, found guilty, I shall be liable for punishments as decided by the authority. I abide to pay the fees as determined by the Fee Regulatory Committee.

Place: Date: Signature of the Candidate List of the Documents Attached (Please Tick ) H.S.C. Examination ( Std. 12th ) Mark-sheet. Diploma in Engineering Examination (if applicable). Qualifying Examination Mark-sheet/ statement of marks. (Submit percentage equivalent certificate in case if mark sheet is in CPI/Grade) Degree Certificate GATE/GPAT Score Card. (Attach Xerox copies of both sides) School Leaving Certificate or Transfer Certificate. Caste certificate for a candidate belonging to Scheduled Caste (SC), Scheduled Tribes (ST) and Socially and Educationally Backward Class (SEBC). Non-Creamy Layer (NCL) certificate, issued after 1st April of the relevant academic year. Certificate of Physical Disability, issued and duly signed by the Civil Surgeon, in case of a Physically Handicapped candidate. Certificate of Ex-Serviceman, duly issued by the Director, Sainik Welfare Board Gujarat State or by the District Sainik Welfare Officer. A copy of certificate of In-Serviceman duly issued by the Commanding Officer of the respective unit in which they are serving. Sponsorship letter issued by the sponsoring authority, in case of sponsored Candidate in the standard format. Such other certificates.

Directorate of Technical Education, Gujarat State, Admission Committee for Professional Courses

Acknowledgement
M.E./ M. Tech./M.Pharm Admission 2011-12
To be Filled by Candidate Name: ________________________________________________________

Office Copy

Discipline Name:____________________ Discipline Code:_____________

To be Filled by Bank Bank Receipt No___________________ Received Rs. 1000/- in cash in Punjab National bank for A/c No-6700000100003238. Bank seal For Office Use Only Received the Application with

Application No:_____________

Dt:

Signature of the Authorised Person. with Name and Designation. Directorate of Technical Education, Gujarat State, Admission Committee for Professional Courses

----------------------------------------------------- Cut From Here ----------------------------------------------------

Acknowledgement
M.E./ M. Tech./M.Pharm Admission 2011-12
To be Filled by Candidate Name: ________________________________________________________

Candidate Copy

Discipline Name:____________________ Discipline Code:_____________

To be Filled by Bank Bank Receipt No_____________Received Rs. 1000/- in cash in Punjab National bank for A/c No-6700000100003238. Bank seal For Office Use Only

Received the Application with

Application No:_____________

Affix Recent Passport Size Color Photograph With candidates Signature Across

Dt:

Signature of the Authorised Person. with Name and Designation. Directorate of Technical Education, Gujarat State, Admission Committee for Professional Courses

----------------------------------------------------- Cut From Here ----------------------------------------------------

Acknowledgement
M.E./ M. Tech./M.Pharm Admission 2011-12
To be Filled by Candidate Name: __________________________________

Bank Copy

_______________________________ Discipline Name:______________________ Discipline Code: _____________

To be Filled by Bank Bank Receipt No___________________ Received Rs. 1000/- in cash in Punjab National bank for A/c no-6700000100003238. Bank seal

Dt:

Important Instructions (Read carefully before filling & submitting the application form)
The candidates seeking admission are advised to study the admission rules vide Education department, Government of Gujarat Notification No.GH/SH/11/2009/PVS/102009/553/S dt 29th May, 2009; and its subsequent amendments available on website and Important Instructions thoroughly before applying for admission. Both GATE/GPAT qualified candidates and non GATE/GPAT candidates shall have to submit the application form. The candidates shall have to pass the qualifying examination with minimum 50% (45% for SC/ST/SEBC candidates) at final year of qualifying examination. However in case of a candidate applying without being eligible his application will be summarily rejected and his application fee will be forfeited. No correspondence will be entertained in this regard. Before submitting the application form at ACPC premises, an application fee Rs. 1000/- (non-refundable) in cash only shall have to be paid at following designated branches of Punjab National Bank located in Ahmedabad between 26/07/2011 to 3/08/2011 during 10:00 AM to 04:00 PM. The bank receipt (included in acknowledgement slip) duly stamped by bank authorities has to be invariably submitted with application form.

List of designated branches of Punjab National Bank

Sr.
1 2 3 4 5 6 7 8

Name of the Branches

Ahmedabad Ambawadi Ahmedabad Ashram Road Ahmedabad Bapunagar Ahmedabad Bodakdev Ahmedabad Chandkheda Ahmedabad Maninagar (E) Ahmedabad Memnagar Ahmedabad Navrangpura

Postal address
Harikrupa Tower, Opp. Guj Colledge Group, Ellisbridge, Ahmedabad, Pin-380006 Popular House, Ashram Road, Ahmedabad, Pin-380009 Radhe Complex, Nr. Shyam Sikhar Tower, Anil Starch Rd, Ahmedabad Super Plaza Bldg,Sandesh Press Rd,Bodakdev,Ahmedabad 7-10, Gr.Floor, Sarjan II, Opp. Janta Nagar, 100ft Ring Rd, Chandkheda, Ahmedabad- 3802424 Maninagar, Ahmedabad Subhash Chowk, memnagar, Ahmedabad 380054 1B,1st floor, Aarambh Complex, Swastik Society, Stadium Road, Navrangpura,Ahmedabad- 380009 7, Shivalik Yash Complex, Opp Shastry Nagar BRTC bus Stop, Narangpura Odhav Road, Ahmedabad-382415

Telephone No.
(079) 26440070, 26561286 (079) 26583280, 26581602 079-22205766 079-26763437 (079) 23292865 (079)22772152 079-27435050 (079) 26448053

9 10

Ahmedabad Nawa wadaj Ahmedabad Odhav

079-27417990 (079) 22871906

11 12 13 14 15

Ahmedabad Relief Road Ahmedabad Satellite Ahmedabad Shastry park Ahmedabad Vanijya Bhavan Ahmeddabad S G Road

Ambica centre, Pathatkuwa, Ahmedabad-380001 Ashapoorna Complex, Opp.Shyamal Row house S.M.ROAD, Nehru nagar Char Rasta, Ahmedabad - 380015 Opp D B School, Kankaria, Ahmedabad- 380022 G-3, Tower B, Shapth IV,Nr., Ananddham jain mandir, S G Highway.

(079) 25508187 079-26766300 (079) 26305447 (079) 25452445 (079)26937305

After paying application fee of Rs. 1000/- in cash at above mentioned designated branches of Punjab National Bank, the duly filled Application form (including acknowledgement and form summary) along with necessary self attested documents, testimonials as mentioned in the application form shall be accepted discipline wise as per following schedule personally only between 27-07-2011 to 3-08-2011 from 11:00 a.m. to 5:00 p.m. at the office of ACPC, L. D. College of Engineering Campus, Opp Gujarat University, Ahmedabad. The application fee of Rs. 1000/- (non refundable) shall be accepted from 26-7-2011 to 3-8-2011 during 10:00 am to 4:00 pm at above mentioned branches of Punjab National bank. However, the application form along with bank receipt (included in acknowledgement slip of form) shall be accepted discipline wise as per following schedule personally only from 27-7-2011 to 3-8-2011 during 11:00 am to 5:00 pm. Sr. Name of Post graduate Discipline Dates of Time of acceptance No. applying for Acceptance of forms Pharmacy (M. Pharm) ONLY 27/07/2011 to 11:00 AM to 5:00 1 29/07/2011 PM Mechanical Engg. & Metallurgy 11:00 AM to 5:00 2. 30/07/2011 PM ONLY Civil Engg., Chemical Engg., 11:00 AM to 5:00 3 31/7/2011 Environment Engg. ONLY PM Electronics & Communication, 11:00 AM to 5:00 Networking, Communication and 4 1/8/2011 PM Web Technology. ONLY 5. Electrical Engg., Power Electronics, Instrumentation & Control and Bio medical Engg. ONLY Computer Engg, Information Technology, Textile Engg & For candidates, who missed the above schedule for Engineering. 2/8/2011 11:00 AM to 5:00 PM 11:00 AM to 5:00 PM

6.

3/8/2011

 The application form received by post/courier shall not be considered for admission. The acknowledgment slip for the applications received will be issued immediately on receipt of application form. The same shall be preserved and brought invariably at the time of CET 2011 for Non GATE/Non GPAT candidates. The eligible Candidate should apply to appropriate discipline for which he is eligible as per eligibility criteria shown in Appendix I of amendment Admission rules 2010 and its subsequent amendment. If he is eligible for more than one discipline, he can apply for as many disciplines, provided he has to make separate application for each discipline along with separate requisite Application fee. The appropriate discipline code and name of discipline have to be clearly mentioned in the application form. The details of the discipline codes are as follows. Sr. Name of Discipline Discipline Code 1 Civil Engineering CE 2 Mechanical Engineering ME 3 Electrical Engineering EE 4 Electronics & Communication EC 5 Instrumentation & Control IC Engineering 6 Chemical Engineering CH 7 Environment Engineering EN 8 Metallurgy MT 9 Textile Engineering TE 10 Computer Engineering CO 11 Information Technology IT 12 Power Electronics PW 13 Bio Medical Engineering BM 14 Networking, Communication & NW Web Technology* 15 Pharmacy PY The appropriate code of qualifying examination passed or appeared for (B.E./B.Tech./B.Pharm) are to be clearly mentioned in the application form. The details of the Qualifying examination Code are as follows. Sr.
1 2 3 4 5 6 7 8

Name of Qualifying examination passed

IRRIGATION & WATER MANAGEMENT MECHANICAL ENGINEERING PRODUCTION ENGINEERING MECHATRONICS INDUSTRIAL ENGINEERING AUTOMOBILE ENGINEERING AERONAUTICAL ENGINEERING ELECTRICAL ENGINEERING

Code
IW ME PR MC I AT AE EE

9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40

ELECTRONICS ENGINEERING INDUSTRIAL ELECTRONICS ELECTRONICS & COMMUNICATION ENGG. ELECTRONICS & TELECOMMUNICATION ENGG. CIVIL ENGINEERING INSTRUMENTATION & CONTROL ENGG. BIOMEDICAL ENGINEERING BIOMEDICAL & INSTRUMENTATION ENGINEERING ELECTRICAL & ELECTRONICS ENGG. POWER ELECTRONICS CHEMICAL ENGINEERING PETROLEUM & PETROCHEMICAL TECHNOLOGY POLYMER ENGINEERING RUBBER TECHNOLOGY PLASTIC TECHNOLOGY BIO-TECHNOLOGY ENVIRONMENT ENGINEERING METALLURGY TEXTILE TECHNOLOGY TEXTILE ENGINEERING TEXTILE PROCESSING ENGG. TEXTILE CHEMISTRY FIBRE TECHNOLOGY WET PROCESSING JUTE AND FIBRE TECHNOLOGY TEXTILE MANUFACTURNG TEXTILE MAINTENANCE COMPUTER ENGINEERING/TECHNOLOGY COMPUTER SCIENCE & ENGINEERING INFORMATION TECHNOLOGY METALLURGY & MATERIALS PHARMACY

E IE EC ET CE IC BM BI EL PW CH PP PO RT PT BT EN MT TT TE TP TC FT WP JF TM TN CO CS IT MM PY

After admitting GATE/GPAT qualified candidates as per merit of the valid GATE/GPAT qualifying marks, the vacant seats if any, will be filled as per merit secured in CET 2011. For non GATE/GPAT candidates, the applicant has to appear for CET2011 in the discipline he has applied for and if he has applied for more than one discipline he has to appear for the CET in as many disciplines as per his application for admission. The detail program for CET 2011 is given in Common Entrance Test 2011 details. The candidates who have appeared in the final semester examination of qualifying exam. are also eligible to apply provided they pass the qualifying examination with minimum 50% (45% for SC/ST/SEBC candidates) at final year of qualifying examination and submit their mark sheet of qualifying examination on or before 05-08-2011, failing which their candidature shall not be considered for further admission process. The candidates who have passed qualifying examination with a mark sheet having CPI/Grade shall have to produce percentage equivalent

certificate issued by university/institute from where they have passed the qualifying examination. All the GATE/GPAT Qualified candidates shall have to submit Self attested copy of both side GATE/GPAT score card. The application of the sponsored candidate shall be submitted by the institute/authority sponsoring the candidate along with sponsorship letter. The sponsored candidate may submit one advance copy of the application to the admission committee. Further they shall have to attach copy of experience certificates and sponsorship certificate (standard format) in addition to other requisite certificates/documents. The caste certificate/Non inclusion in creamy layer certificate for SEBC category/ Medical Certificate for Physically Handicapped candidate /Exserviceman category certificate /Sponsorship certificate etc should be duly stamped, signed and issued by the authority empowered by Government of Gujarat. The candidate belonging to SEBC category shall have to produce to the effect of non-inclusion in Creamy Layer in addition to caste certificate; such certificate shall have been issued on or after the 1st April 2011. The acknowledgement slip and a photo identity proof must be produced at the time of the CET-2011 for verification. No candidate shall be permitted to appear in the CET-2011 without the valid acknowledgement slip. It must be preserved even after the CET2011 and it should be presented at the time of counseling for admission. The Examination number for CET 2011 is same as the application number allotted to you by this committee. If there is change in the examination Number, the same shall be notified on the Admission Committee Website one day before the CET 2011 schedule date. Incomplete application forms and application form without self attestation or incomplete documents or application fee bank receipt (Included in acknowledgement slip) are liable to be cancelled. No separate call letter shall be issued for appearing in CET2011/Counseling. The candidate shall have to remain present as per schedule mentioned in admission schedule at his own cost. The candidates shall have to bring all original certificates/ testimonials/documents for verification at the time of counseling. The candidate shall have to pay the requisite tuition fee at the time of counseling; the details of same will be available shortly with the programme of counseling at the website www.jacpcldce.ac.in. The candidates who are applying on equivalent qualification basis, shall have to submit the equivalency certificate issued by the University from where they have passed the qualifying examination, failing to do so their candidature shall not be considered for further admission process.
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