APPLICATION FOR ADMISSION TO THE FIRST YEAR OF THREE YEAR DIPLOMA COURSE IN ENGINEERING Preference for branch: Civil EngineeringComputer EngineeringMechanical Engineering Name of the Candidate: (As per SSC Certificate) Date of birth : Gender: --- Male Female Category: --- CHRISTIAN OPEN SC ST VJ DT NT OBC SBC If belonging to Minority / Backward Class, submit duly attested photocopies of necessary documents Particulars of Academic Record: Class: VIII Class: IX Class: SSC Marks obtained in SSC examination Grand Total Mathematics Science Whether passed SSC exam with Technical/ Vocational subjects ? --- Yes No Whether passed intermediate grade drawing exam? --- Yes No Whether passed SSC from school located in Maharashtra State? --- Yes No If SSC passed from outside Maharashtra State, whether father is domiciled in Maharashtra --- Yes No Profession of Parents or Guardian along with residential and professional address: Professional Address is same as Residential Address Declaration to be signed by the Candidate: The information given by me in my application is true to the best of my knowledge and belief. I understand that if any of the statements made by me in the application form or any information supplied by me in connection with my admission is later on at any time, found to be false or incorrect, my admission will be cancelled, fees forfeited and I may be expelled from the college by the Principal / Dean of the Department. I have not been debarred from appearing at any examination held by any Government constituted or statutory examination authority in India. I fully understand that the offer of a course will be made to me depending on my inter se merit and availability of a seat at the time of scrutiny of my application, when I actually will report to the admission authority according to the schedule of admission. I am fully aware that the College Authorities will not make any correspondence with me regarding admission. I am also aware that it is entirely my responsibility to see the notices on the notice board of the college/website. I am aware that any rule imposed by the MSBTE such as ‘imposing limits on the number of attempts permissible to pass any examination’ shall be binding on me. I fully understand that the fees to be paid are determined by the Fee Regulating Authority appointed by Govt. of Maharashtra and I will abide by the fee fixed by the committee. Signature of Candidate Declaration to be signed by the Parent/ Guardian: I declare that the particulars furnished by my son/daughter/ward in this application form are correct to the best of my knowledge and belief. I undertake and abide myself to pay on behalf of my son/ daughter/ ward such fees, charges etc. which Government of Maharashtra/ MSBTE/ Institute may levy from time to time by due date and in the event of failure on my part and/or on the part of my son/daughter/ward, the Principal of the College / Dean of the Department may take such action against my son/daughter/ward, as he may deem fit. I agree to sign the requisite agreement bond as prescribed by the Government. I agree to pay the fees to be paid fixed by the Fee Regulating Authority of Govt. of Maharashtra Signature of Parent/ Guardian Attested copies of the following certificates to be attached with the application Std. VIII Marksheet / Proforma Z Std. IX Marksheet / Proforma Z S.S.C. Marksheet School Leaving certificate from the institution from which the candidate passed qualifying exam Proof of Nationality Domicile Certificate of Student / Birth Certificate Caste Certificate/ Caste Validity Certificate/ Valid Non-Creamy Layer Certificate (If applicable) Eligibility Certificate from MSBTE (incase of candidates who have passed qualifying exam from outside Maharashtra State) & Verification Report/ Certificate from previous Institution / Board (if applicable) Gap Certificate (if applicable) Physical / Medical Fitness certificate from a registered medical practitioner (original copy only) Acknowledgement of Registration at Facilitation Centre Student's Photograph
