Form No. :No………………………… NATIONAL INSTITUTE OF TECHNICAL TEACHERS’ TRAINING & RESEARCH SHAMLA HILLS, BHOPAL 462 002 (M.P.

) INDIA
Size 3.5 cm x 2.5 cm

Photograph (Self Attested)

APPLICATION FORM FOR ADMISSION IN M.E./M.Tech. Admission Year 2012-2013
Application Form Fee ` 750/- for General/OBC candidates & ` 450/- for SC/ST candidates

FOR OFFICE USE ONLY
1. GATE : Score:………………... Year: …………………… Discipline: …………….. Rank :………………….. Application Reg.No. ______________ Sch. No. ________________________ Branch: 2. Aggregate % at Degree level/ Equivalent 3. Category (SC/ST/OBC/ General/Others) 4. Status of Candidature 5. Payment Details : (i) GATE Demand Draft.…………… (ii) Sponsored (iii) Non GATE - Non Sponsored Drawn on ………………... Amount `………………… Date …………..…………..
Date of Admission.. ………..

TO BE FILLED BY THE CANDIDATE
1. Personal Details & Correspondence Address:
(i) (ii) (iii) (iv) Name (in Capital) Father’s Name Mother’s Name Address for Correspondence
Pin - …………………………………. E-mail ID: ……………………………………………………… Telephone: …………………………………. Mob. No……………………

(v)

Date of Birth

………/……/…………… DD / MM /YYYY

Gender: Male/Female Place of Birth________________ State _____________

(vi) (vii)

Category

SC/ST/OBC/General/Others………………………… Blood Group ………………….. Nationality ……….……………………………. Religion ……………………………………………

2. Details of Under Graduation & Qualifying Examination Level
(i) (ii) Branch at UG Level Aggregate Percent of Marks in the qualifying UG Exam Details of GATE Examination Exam : Total Marks:…………………………….…… Obtained Marks:…………………………….. Percentage :…………………………… Year of Passing …………………. Discipline of GATE ……………… Percentile ………………………... GATE Score ………………………

(iii)

a) b) c) d)

E. in Power Systems Write the Name of programme applied for : 4.) Any other examination 5. / Demand Draft No. if required) Post Held Pay Scale/ Salary Experience From Nature of work To Name & Address of Employer 6.No.Tech/Equi. in Construction Technology & Management M.Tech.Tech. Hostel Accommodation Needed: YES NO Date : ………………………………………. Signature of the Candidate Name:………………………………… . Experience in Chronological Order: (Use separate sheet. (i) (ii) (iii) Details of Programme Applied For : PG Programmes Offered M. Place : ……………………………………. Issuing Bank with branch 7. Educational Qualifications Exam / Degree Subjects / Branch Board / Institute and University Year of Passing Division Total marks obtained % marks / CGPA (i) (ii) (iii) (iv) 10 th Higher Secondary/10+2 UG Level (B.No.E. Details of Application Form Fees: ` Dated Bankers Chq. in Computer Technology & Application M./B. S.3. S.

is working in ……………………………………………………………………. / Demand Draft th Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Note: At the time of admission. I assure that if admission is given to me. Bhopal.E. Bhopal.…………… on Regular / Full time basis and he / she is sponsored and permitted to join the Full time M. / Ms.List of enclosures (self attested photocopies): Self attested copies of following documents as applicablea) b) c) d) e) f) g) h) i) 10 Marksheet / Certificates as proof of Date of Birth Higher Secondary/10+2 Marksheet/Certificate Marksheet/Grade Cards of Qualifying Examination (B. all certificates and documents in original including migration & character certificate. (Name & address of Employer/ Organization/Institute) as………………………………. In case any of the information given by me is found incorrect my application is liable to be rejected / admission is liable to be cancelled. I shall abide by the rules and regulations of the institute. ……………………………………………………………………(Father’s / Husband name) ……………./M.Tech Programme of NITTTR. statutes. Further. If selected as a sponsored candidate the organization has no objection and he/she will be allowed to continue full time M.E.Tech Programme till the completion of the programme at NITTTR. Declaration by the Candidate I hereby declare that the information given above is correct.) GATE Score and GATE Admit Card Sponsorship Certificate with No Objection Certificate from present employer(For sponsored candidate) Caste Certificate (For SC/ST/Other Backward Classes ) in Govt.Tech.E. Signature of the Candidate Place : …………………………… Date : ……………………………. Counter Signature of Father / Guardian Employers Certificate for Sponsored Candidates This is to certify that Mr. Date: Place: Signature of Competent Authority with official seal . ordinances of the affiliating university and changes incorporated therein from time to time and shall maintain the discipline of the Institute. / B./ MCA etc./M. of India Format Income Certificate from competent authority (for other Backward Classes) Two passport size photographs Bankers Chq.……………….

(Signature of admission committee members) (Signature of candidate at the time of admission) Date : ………………………………… .Tech....2.... UG Level year of passing …………………… Percentage/CGPA ………………………………. 5. Formalities to be completed (if any) ……………………………………… By date ……………………………. Name: ………………………………….Verification Sheet (for Office use only) 1./MCA/Equivalent ……………………………………………… 4.E.. Score …………………Percentile………………… Verified and admitted provisionally to the First Semester Full Time course in ……………………………………………. GATE : Year of passing ………………………./SC/ST/OBC/Others: …………………… 3.. Category : Gen../B.... Branch at B.

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