GOVT. ENGINEERING COLLEGE, AJMER Direct Admission B. Tech ...
GOVT. ENGINEERING COLLEGE, AJMER Direct Admission B. Tech ...
GOVT. ENGINEERING COLLEGE, AJMER Direct Admission B. Tech ...
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<strong>GOVT</strong>. <strong>ENGINEERING</strong> <strong>COLLEGE</strong>, <strong>AJMER</strong><br />
<strong>Direct</strong> <strong>Admission</strong> B. <strong>Tech</strong> – 2011<br />
Application Form<br />
Preference of branch in order:<br />
1 ________________________________<br />
2 ________________________________<br />
3 ________________________________<br />
4 ________________________________<br />
5 ________________________________<br />
1 Name of Candidate_______________________________________________<br />
( As in Secondary (X) Mark- Sheet)<br />
2 Father’s Name___________________________________________________<br />
3 Mother’s Name__________________________________________________<br />
4 Full Postal Address ( for Communication)<br />
_______________________________________________________________<br />
_______________________________________________________________<br />
_______________________________________________________________<br />
Phone No. ____________________ Mobile____________________________<br />
PHOTO<br />
5 Sex (Male/Female) 6 Category-I (GEN/SC/ST/OBC)<br />
7 Date Of Birth .... …/… / … .... Age As On 1.10.2011……..…Years…………Months<br />
D D/ M M/ Y Y<br />
8 EDUCATION<br />
Class Subjects % Examination<br />
Board<br />
Town State Year of passing<br />
X<br />
XII<br />
9 Domicile State______________________________________________________<br />
10 Did you appear in RPET-2011 (tick) Yes/No<br />
if Yes then RPET-2011 Roll No. ……………….RPET-2011 Rank …………………..<br />
11. Did you appear in AIEEE-2011 (tick) YES/NO.<br />
If YES then AIEEE-2011 Roll No.............................AIEEE-2011 Rank........................<br />
12. Details of RPET counseling: (fill and tick as applicable)<br />
a. If you are already admitted through RPET-2011 counseling, please give following detail<br />
Name of the institute and branch finally reported by the<br />
candidate after two counseling stages of RPET-2011<br />
Admitted through RPET-2011 counseling number<br />
First Counseling / Second Counseling<br />
b. Seat allotted through counseling but not reported<br />
Allotted through RPET-2011 1st counseling Name of the institute and branch allotted<br />
Allotted through RPET-2011 2nd counseling<br />
c. Seat not allotted in 1st and 2nd counseling (please tick which ever is applicable)<br />
Seat not allotted in 1st counseling Seat not allotted in 2nd Seat not allotted in both the
counseling counseling<br />
13. ENCLOSURES (as applicable)<br />
Declaration:<br />
a. Attested copy of mark sheets /certificates of X,XI,XII for date of birth & eligibility<br />
b. Domicile certificate in case of above Sr.no. 09.<br />
c. Cast certificate issued by competent authority (of the rank of Tehsildar /executive Magistrate<br />
or above)<br />
d. RPET-2011 Award sheet or AIEEE-2011 Award sheet as applicable<br />
e. Copy of earlier reporting slip<br />
f. Medical Certificate (Available on RPET-2011 website)<br />
g. Any other certificate as required by the admission committee of the concerned institute.<br />
I do solemnly affirm that the statement and information, furnished by me along with documents<br />
are correct. I realize that, if any information furnished therein is found to be false in material particulars, I<br />
shall be liable to criminal prosecution as well as to far go my admission and to be discharge from the<br />
college, if already admitted.<br />
Signature of Parent/Guardian<br />
Signature of Candidate<br />
………………………………………………………………………………………………………<br />
For Office Use Only<br />
<strong>Direct</strong> <strong>Admission</strong> -2011<br />
PROVISIONAL ADMISSION CARD<br />
Inward No…………….<br />
Name………………………………………..<br />
Father’s Name………………………<br />
Candidate’s merit (Among the Candidates applied to your Institute):……………………………..<br />
Status: Admitted/Not Admitted<br />
Name of the Branch in which admission is given: ………………………………………………...<br />
Signature of <strong>Direct</strong>or/Principal with Seal ………………………
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