COMPUCOM INSTITUTE OF INFORMATION TECHNOLOGY & MANAGEMENT

AN ENGINEE RING AND MANAGE ME NT COLLEGE

(Approved by AICTE, New Delhi & Affiliated to University of Rajasthan)
Sp-5, EPIP, Sitapura RIICO Industrial Area, Jaipur 302022 (Rajasthan)
ADVANCE REGISTRATION FOR MANAGEMENT SEATS
(Photocopy of this form is also valid) Session: 2008 -2009

Name of Applicant: Date of Birth: ---/---/-----

Father’s Name:
Address: Contact Telephone No.:
Land Line

Mobile

Portfolio of Programmes : Please tick mark your preference / choice of course

B.E. – 1st year / 2n d year - Lateral entry for diploma holders Reference / Choice
•1 Electronics and Communication [ ]
•2 Electronics and Instrumentation [ ]
•3 Computer Science and Engineering [ ]
•4 Information Technology [ ]

B.C.A. [ ] M.B .A. [ ] M.C.A. [ ] M.Sc (IT) [ ]

Educational Qualification:
Class % of Marks Board / University
Class X
Class XII
Passed / Appearing in Final
Diploma in Engineering
Passed / Appearing in Final
Graduation
Stream: B.A. /B Com / B.Sc.
or
Passed / Appearing in Final
Please Note: 1.Students passed or appearing in class XII are eligible for B.E. / B.C.A. course and students passed
graduation or appearing in final year are eligible for M.B.A. / M.C.A. course.
2. Diploma holders/ students appearing in diploma (final year) are eligible for direct entry in B.E. 2nd year
3. All admissions in our college are done in accordance with State / University guidelines strictly
based on merit.
4. Registrations shall be applied first towards management seats then towards vacant seats if any.

How you have come to know about our college?

1. Through Newspaper : Name
2. Friend : Name
3. Coaching Institute/Counsellor : Name
4. CIITM Staff : Name
5. Your School / College Staff : Name
Signature of Applicant:
For Office Use Only:

Registration No. : 2006/B.E. / B.C.A. / M.C.A. / M.B.A. / M.Sc (IT)

Registration Amount of Rs. 5000/- - Received / Not Received
(In form of a DD in favour of "CIITM, Jaipur" payable at Jaipur)
(To be adjusted against Admission Fees)
Merit No. B.E. / B.C.A. / M.C.A. / M.B.A. / M.Sc (IT)
Signature of Admission Coordinator: