Admission Form (ME- II) - Modern College of Engineering

PROGRESSIVE EDUCATION SOCIETY’S
MODERN COLLEGE OF ENGINEERING
1186-A, Off J.M. Road, Shivaji-nagar, Pune 411 005
Phone No. 25533638 / 648 Fax No. 020 - 25530957
№ №:
APPLICATION FOR M.E.ADMISSION
Academic Year 2012-2013
Please tick (√) for the appropriate course
( ) M.E. (Mechanical Engineering) – Heat Power
( ) M.E. (Electrical Engineering) – Control Systems
( ) M.E. (Electronics & Tele communication) – Signal Processing
( ) M.E. Computer Engineering
PHOTO
Application form, certificates & supporting documents along with form fee to be paid by Bank DD of
Rs. 800/- (Rs 500 for SC/ST) in favor of ‘The Principal, Modern College of Engineering Pune-5’
should be submitted to the following address:
The Principal,
P.E.S. Modern College of Engineering
1186 A, off J.M. Road, Shivaji-nagar, Pune – 411 005.
۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰۰
1. Name in Full (in block letters) :__________________________________________________
(Surname) (Name)
2. Postal Address for Correspondence : __________________________________________________
___________________________________________________
___________________________________________________
Telephone No. /Mobile No. :__________________________________________________
E-mail address :__________________________________________________
( Note: All communications will be made on this email address) and Mobile No.
3. Domicile :__________________________________________________
(Maharashtra or other state)
4. Nationality :__________________________________________________
5. Permanent Address :__________________________________________________
__________________________________________________
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6. Date of Birth (dd /mm /yy) :__________________________________________________
7. (a) Do you belong to Backward
Class/S.C./S.T.? : _________________________________________________
(b) If Yes, mention clearly : _________________________________________________
8. Caste :_____________________ Religion:__________________________________________
9. Father’s/Guardian’s Full name :________________________________________________
Address :_________________________________________________
9.1 Mother’s Name - _________________________________________________
10. Father’s/Guardian’s Occupation :_________________________________________________
11. (a) Academic Record :
Course &
Exam
Annual Income : Rs.______________________________________________
College Attended
Month & Yr
of passing
№ of
Attempts
University /
Board
Total Marks
Obtained
Maximum
Marks
(out of)
1 2 3 4 5 6 7 8
I Yr Engg/
Diploma
II Yr Engg
III Yr Engg
B. E.
(Final Yr)
Other Exam
Are you GATE Qualified Candidate
b) Work Experience:
If yes your GATE score
& the year
Name of the Organization/ Industry/Institute Period Nature of Work
Percentage
12. Presently Employed or Unemployed? : Yes / No
If employed, give details (e.g. Designation/Post : _____________________________________
Regular / Temporary, Date of Appointment, :_____________________________________
Length of service etc.)
: ------------------------------------------------------------
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13. Sponsorship certificate attached? : Yes / No
(Note – Employed candidates will have to produce a certificate from the employer in the Prescribed
Format, without which the application may not be considered).
14. Declaration to be signed by candidates belonging to SC/ST.
I understand that the admission given to me against the quota for reserved category is purely
provisional and will be cancelled if my caste certificate is rejected by the Director of Social
Welfare, Maharashtra State.
Date: ……………….
Place: ……………… (Signature of the Candidate)
15. Declaration by the father/guardian of the applicant
I do hereby declare that -
(i) The particulars furnished by my son/daughter/ward in this application form are correct to
the best of my knowledge.
(ii) On behalf of my son/daughter/ward, I undertake and bind myself to pay, by due date, the
fees/ charges for the admission. In the event of failure on my part or on the part of my
Son/daughter/ward, The Principal of the college may take appropriate action against my
son/daughter/ward.
Date:……………… Signature ………………..
Name: …………………..
Place:……………. (Father/Guardian of the applicant)
16. The information given above is true to the best of my knowledge and belief.
………………………………
Signature of the candidate
………………………………………………………………………………………………………………………………….
Application fees Details (Application Fee of Rs. 800/- / Rs. 500/- has been paid by DD drawn in favor
of “Principal, Modern College of Engineering, Pune - 5” payable at Pune.
D.D. No. ___________ Dated
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(Enclosure № I)
UNDERTAKING
1 I have read all the rules of admission for the current year and after understanding those rules, I
have filled in this form of application for admission for current year.
2. The information given by me in my application is true to the best of my knowledge and belief.
3. I have not been debarred from appearing at any examination held by any Government
constituted or statutory examination authority in India.
4. I fully understand that the offer of a course or branch of engineering will be made to me
depending on merit and availability of a seat at the time of scrutiny of my application, when I will
report to the admission authority according to the schedule of admission.
5. I understand that addition / modification in the documents attached with the application form at
the time of submission will not be entertained for the purpose of claims/concessions etc. in
connection with my admission.
6. I hereby, agree to confirm to any rules, acts and laws enforced by Government & Institution and
I hereby undertake that so long as I am a student of the college, I will do nothing either inside or
outside the college which may result in disciplinary action against me under the rules, acts and
laws.
7. I understand that my admission is provisional and may be cancelled by the Principal on
technical governance or on discipline grounds. I fully understand that the Principal of the college
where I would be admitted, will have right to expel/rusticate me from the college for any
infringement of the Rules of conduct and discipline prescribed by the MCOE/Pune University from
time to time and the undertaking given above.
8. I understand that ragging in any form is punishable and I hereby solemnly aver and
undertake that
a) I will not indulge in any behavior or act that may be constituted as ragging. I will not
participate in or abet or propagate through any act of commission or omission that may be
constituted as ragging under clause 3 of the Regulations (UGC/AICTE Regulations on Curbing the
Menace of Ragging in Higher Educational Institutions, 2009).
b) I hereby affirm that, if found guilty of ragging, I am liable for punishment according to clause
9.1 of the Regulations, without prejudice to any other criminal action that may be taken against me
under any penal law or any law for the time being in force.
c) I hereby declare that I have not been expelled or debarred from admission in any institution
in the country on account of being found guilty of, abetting or being part of a conspiracy to
promote, ragging; and further affirm that, in case the declaration is found to be untrue, I am aware
that my admission is liable to be cancelled.
Signature ----------------
Name of the Candidate
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(Enclosure no. II)
SPONSERSHIP CERTIFICATE
(To be issued by the sponsor)
This is to certify that Shri. / Smt. ________________________________________________has
been working as a __________________ in_____________________ Department in this
organization/Institution since __________________.
He / She is permitted to study for the M.E. Degree at Modern College of Engineering, Pune-05.
If he/she is admitted to the said course, the working hours of his/her duties in this
organization/institution will be suitably adjusted and he/she will be permitted to attend the college
as a full time student during the working hours of the college till the completion of his/her course.
Signature and designation of Sponsoring Authority
Date :
Place : Seal
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UNDERTAKING OF RESULT AWAITING STUDENT
(Enclosure no. III)
For Student applying in a Master’s program
I, son/daughter of __________________
solemnly affirm and undertake that I have been provisionally admitted in Modern College of
Engineering affiliated to University of Pune for a __________________________________________
programme as a “result awaiting” student. I am fully aware that my admission is conditional subject to
passing my pre-requisite Degree with a minimum of 50 % marks / 45% marks (in case of candidate of
backward class categories belonging to Maharashtra State only). In case, I fail to clear my examination
(in which I have already appeared in) with percentage of marks as per AICTE / UoP requirement, I shall
withdraw my admission otherwise the university/institute has the right to cancel my admission at any
point and that I shall agree to the reimbursement of fees as per the norms for cancellation of admission.
___________________ ____________
Signature of Applicant Date
Note: This is just a format, this undertaking has to be made on Rs.20/- stamp paper and has to be
stamped and signed by an advocate.
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CERTIFICATES REQUIRED TO BE SUBMITTED IN ORIGINAL ALONG WITH
ONE SET OF PHOTOCOPIES AT THE TIME OF ADMISSION
Sr. № CERTIFICATES
I
Candidate should Tick (√) in the row captioned as Submitted
B.E. /B. Tech. AMIE Marks Statement.
Appeared candidates will have to give undertaking as
per Enclosure no. III
II Bona-fide Certificate. (Appeared candidates).
III
IV
SSC Certificate for Birth Date verification / Birth
certificate.
Leaving or Transfer Certificate from College last
attended.
V GATE Score, Marks Memo
VI Backward class certificates if applicable
VII Caste validity certificate.
VIII Non creamy layer certificate
IX Physical handicap certificate if applicable
X
Sponsorship certificate in given pro-forma for
Employed candidates / sponsored (Enclosure № - II )
XI Experience certificate, employment certificate.
XII
University Migration certificate for students other
than Pune University.
XIII Domicile Certificate
XIV Nationality Certificate
Submitted
(√)
Remarks of
Scrutiny Committee
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Application
№
FOR OFFICE USE:
Name /
Initials
BE
%
Sponsor
Non-
GATE
GATE
Sponsor Non- Sponsored
GATE OPEN OBC SC ST
VJ DT
NT-
AB CD
Tick (√) in the shaded area as applicable and put the details/score/weight in the un-shaded cell
Signature of the Verification & Scrutiny officers: (1) (2)
Non-
Sponsor
Non-Gate
Work
Experience
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