YESHWANTRAO CHAVAN COLLEGE OF ENGINEERING

/ZdDEh
Hingna Road, Wanadongri, Nagpur- 441 110

Application Form for the Admission to

Post-Graduate Programme for the year 2011-2012
FOR OFFICE USE ONLY
1. Application No. ________________ 2. Registration No.: ___________ 3. Category : GATE/Non-GATE/Sponsored
4. GATE Score : _________________ 5. Qualifying Exam. Marks : _______________________________________
6. Professional Experience : _____________________________________________________________________
(For Sponsored Candidates Only :
7. Entrance Exam./ Interview Score : _________ 8. Eligible / Not Eligible :___________9. Remark, if any: _________
Date :_____________________

Verified by : _____________________

Provisionally admitted to first Semester Post Graduate Course in : __________________________

1. Name of Candidates:_________________________________________________
(As written in the qualifying exam. certificate )

2. Address for Correspondence : _________________________________________

__________________________________________________________________





Phone: ________________ Fax : ______________ E-mail : __________________

3. Permanent Address : ________________________________________________
Phone: ____________________ Fax : __________________________________

E
K

4. Date of Birth

  D D z z z z
5. Details under which admission to M.Tech. (Full Time) Course is being sought:
(Please tick mark ( 3 ) in appropriate box, as applicable)
a. Name of the Department : __________________________________________________________
b. Name of the Programme : __________________________________________________________
c.

Male

Female

d. Open

SC

e. GATE

Non-GATE

f.

ST

OBC

Are you a sponsored Candidate? YES / NO

If Yes,
Details of Post Held : _________________________Organisation___________________________
Work Experience : _________________________ Year ______________ Month ______________

6. a)

Details of Qualifying Examination *:

Year of Passing

Degree Obtained

Branch

University

% of Marks Obtained

(* If final year result is awaited, provide details of Pre-final exam. results under items 6c)

Remarks, if any

b) Details of GATE score on the basis of which admission is being sought

Year : _________________ Branch______________________ Percentile________________________
b) Details of Pre-qualifying Examination
(To be fiiled in only when qualifying result is awaited)
Year of Passing

7. a)

Name of Exam.

Branch

University

% of Marks Obtained

Details of Professional Experience

Name of employer

Post Held

Date of
Joining

Date of leaving

Length of service

Nature of Duties

8. Fathers / Guardians Name & Address : __________________________________________________

__________________________________________________
...
DECLARATION
I, undersigned, hereby declare that all the information furnished above is true. If admitted to the course, I shall
abide by rules and regulations of the college and the university in force and any changes in them from time to time.
Further I shall attend the theory and practical classes regularly as per the time table and shall comply with the minimum
attendance criterion prescribed by the university, I understand that the fees may be revised by the college at any time
and I shall be liable to pay the same.
Place : ___________________

Signature of Student

Date : ___________________

Name : ________________________

....
SPONSORSHIP CERTIFICATE
TO WHOM SO EVER IT MAY CONCERN
This is to certify that Mr. /Mrs. _______________________________________________________________
has been working in our concern as _________________ since _________________ up to till date.
Mr. /Mrs. ______________________is being sponsored by us to seek admission to the Post Graduate degree
program for the academic session 2011-2012 and we assure your good self he/she will not be withdrawn midway till the
completion of the course. He/ She will be fully under the administrative control of the institute for the period of the course
and will be paid full salary by us for the duration of the course.
We wish him/ her success in future.
Signature of authority
Date : ___________________

Name : ________________________
Designation of authority
Office seal

.
Copies of certificate enclosed
(tick mark ( ) in appropriate box, as applicable)
1.

Qualifying Exam Certificate

4. Copy of transfer certificate

7. Work Experience Certificate

2.

GATE Score card

5. Caste Certificate

8. Marks list of Pre-Qualifying Exam.

3.

Mark list of qualifying exam

6. Caste Validity Certificate

9. ___________________________