Admission Form for M.E - JSPM

Jayawant Shikshan Prasarak Mandal, Pune
APPLICATION FOR ADMISSION TO POST GRADUATE COURSE IN ENGINEERING
Application for admission to M.E. program in __________________________
Name of College: Imperial College of Engineering and Research
(Application will consider with respect to the college name)
Seat Category: GATE NON GATE
SPONSERED NON NON SPONSERED
GATE score: -------------- Year: ------------- Discipline: -----------------------
(Note: Sponsored candidate will have to produce NOC in prescribed format from
their employer)
01. Name in Full(Surname First) :----------------------------------------------------------
02. Mother’s Name :--------------------------------------------------------
03. Address for correspondence :----------------------------------------------------------
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04. Telephone No.: ------------------------------- 05. Mobile No.: -----------------------
06. Email ID : -------------------------------
07. Perment Address :------------------------------------------------------------------------
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08. Domicile : Maharastra : Yes/No If No mention: -------------------------------
09. Date Of Birth :--------------------------
10. Gender : Male/Female
11. Category :
OPEN SC ST OTHERS
1
PASSPORT
SIZE
PHOTO

Sr.
No.
12: Academic details:
Exam Passed University/ Board Specialization Year of
01 B.E/B.Tech.
02 HSC/Diploma
03 SSC
Sr.
No.
13. Teaching/Industrial/Research experience :
Name & Address of
Employer
Teaching Experience: ----------------------
Industrial Experience: ---------------------
Total Experience : ---------------------
Declaration :
2
Passing
Designation Period of Employment
% of
Marks
From To Duration
a) The information given is true to the best of my Knowledge & belief.
b) I will submit all the necessary documents as per the requirement of concern
authority failing to which my admission will stand cancelled.
c) I undertake to pay full fees as per norms and schedule of the college.
d) I hereby undertake to abide by the rules & regulations at present in force &
Place:
also changes made from time to time. I will follow discipline of the Institution.
Date: (Signature of the Candidate)

How to apply:
The prescribed application form is available in the college office during working
hours on payment of Rs.500/-.Also application form can be downloaded from the
website and attach DD of Rs. 500/- in favour of “ Principal Imperial College of
Engineering and Research, Pune” payable at Pune. Submit the application form
along with DD and relevant documents before 15 days from release of advertisement
in newspaper.
Contact Us:
Prof. Dr. Sachin Admane
Principal, JSPM’s ICOER.
+91 8888577455
3
Prof. Vijay Sawant
Campus Director, JSPM, Wagholi.
+91 9763777777