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TM

MAEER

MIT SCHOOL OF DISTANCE EDUCATION


RBA Code : 20080120
S. No. 124, Paud Road, Kothrud, Pune-411 038, India
Tel.: 020-25465882/83 Fax : 020-25454918 E-mail : admissions@mitsde.com
Admission No.
ADMISSION FORM

To
Passport
The Director Size
2 Photos
Student Category

Civilian International student/NRI Defence Para-Military Police MIT Staff

First Name Middle Name Last Name

Birth Date : d d m m y y y y

I request for grant of admission to the below mentioned program being offered by your institute for the academic year 20___.
(Tick the appropriate program)

Two Years Programs


Post Graduate Diploma in Business Administration (PGDBA) with specialization in
¨ Marketing ¨ Finance ¨ Human Resource ¨ Operations ¨ Information Technology ¨ Supply Chain ¨ Materials

One Year Program


¨ Post Graduate Diploma in Piping Design And Engineering ¨ Post Graduate Diploma in Human Resource Management
¨ Post Graduate Diploma in Fire And Protection Engineering ¨ Post Graduate Diploma in Operations Management
¨ Post Graduate Diploma in Energy Management ¨ Post Graduate Diploma In Information Technology
¨ Post Graduate Diploma in Risk & Insurance Management ¨ Post Graduate Diploma In Wealth Management
¨ Post Graduate Diploma In Retail Management ¨ Post Graduate Diploma In Supply Chain Management
¨ Post Graduate Diploma In Project Management ¨ Post Graduate Diploma In Materials Management
¨ Post Graduate Diploma In Marketing Management ¨ Diploma In Business Administration
¨ Post Graduate Diploma In Financial Management ¨ Diploma In Retail Management

Address For Communication Permanent Address


(Students are required to give both the addresses)
Address : Address :

City : State : City : State :


Country : Pin Code : Country : Pin Code :
Tel.: Mobile : Tel.: Mobile :
E-mail : E-mail :
E-mail : E-mail :

For MITSDE Use Only


Admission Status Form Status Date of Registration Registration Number
Confirmed Provisional C I
Address of Organization (for Working Professionals is compulsory)

(To be filled by Working Personnel only.) To be filled by Defence/ Para Miltary/ Police Personnel only
Name & Address of the Organization : Service Number :
Rank / Cadre :
Total Service (years) Date of Commission / Enrolment:
Current Designation: Arms / Services : Army Navy Air Force
Contact Tel. No.: Total Service (years)
E-mail : (Personnel from Armed Force / Para Military/ Police are required to
attach a letter on official letterhead giving proof of services)

Academic Details (Degree / Diploma)


Examination Degree Institute / University Year of Passing Elective / Specialization Class / Division % Marks

Fee Details
I am remitting an amount of Rs / $ (Details are as below):

For Indian Residents : For Non Resident Indian / Foreign Residents:


1. Registration Fees : Rs. 1000 1. Registration Fees : $ 100
2. Prospectus Fees : Rs. 1000 2. Prospectus Fees : $ 100
3. Programme Fees : Rs. __________ 3. Programme Fees : $ __________
Total Fees : Rs. __________ Total Fees : $__________

Mode of Payment : Cash (Only for Walk-in Submission) DD


DD No. Date : Bank Name :
Attested Xerox copy of following Documents Attached herewith (Please Tick) :
Degree Certificate Diploma Certificate Provisional Certificate Marriage Certificate Photographs 2 nos.

Service Certificate (in Case of Diploma holders or Defence / Paramilitary / Police) Photo Identity

Certificate of Undertaking
I declare that the information provided by me in this application form is true to the best of my knowledge. I am fully aware that in case
any information provided is found erroneous, it will result in cancellation of my registration / admission. I have read the prospectus
carefully and agree to abide by all the rules and polices of the Institute.
Place :
Date : (Signature of Applicant)
FOR MITSDE USE ONLY
Form filled completely
If no reason 1) 2) 3) 4)
Certificates not attached Graduation Diploma Provisional Other
Certificates not attached Form Incomplete / not signed Photographs not attached (2 nos)
Service certificate not attached Registration Fee not remitted.
(For diploma holder only & defence personnel only)