You are on page 1of 6





Full Name of Father/ Guardian : __________________________________________ 4.(TECHNOLOGY) in Electronics & Telecommunication Engineering Academic Year 2014 . Full Name in Capital Letters : __________________________________________ 2. Guardian’s relation with applicant : __________________________________________ 5. Date of Birth : __________________________________________ 3. with STD code : __________________________________________ Mobile No. Permanent Address : __________________________________________ __________________________________________ __________________________________________ __________________________________________ 6. : __________________________________________ Email ID : __________________________________________ Present Address (for Communication) : __________________________________________ __________________________________________ __________________________________________ __________________________________________ Telephone No. Telephone No.APPLICATION FORM FOR ADMISSION TO Ph.15 PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE FILLING THIS FORM : INFORMATION OF CANDIDATE 1. : __________________________________________ Email ID : __________________________________________ 2 .D. with STD code : __________________________________________ Mobile No.

Details of Professional Experience : Sr. specify category and name of caste : Yes / No 8. No. Do you belong to Reserved Category (SC/ST/DT/NT). Name of the Industry/ Organization /Institution Period of Working From To 2. Name of qualifying Post Graduate Degree Examination : __________________________________________ 11.7. Whether passed final Post Graduate Degree Examination in first attempt : Yes / No 12. Year and month of qualifying PET examination : __________________________________________ 10. Month and Year of passing Post Graduate Degree Examination : __________________________________________ __________________________________________ 14. Score in PET examination : __________________________________________ 9. 3 . If yes. Name of Institution and University from which Post Graduate degree is obtained : __________________________________________ 13. 5. Marks obtained in Post Graduate Degree Examination : Semester Marks Obtained Grand Total Overall % and class Obtained Ist Year IInd Year 15. 1. 3. 4.

16. with STD Code : __________________________________________ 17. (of all years/semesters) : (iv) PET score card (if applicable) : (v) CONCOL letter for getting exemption (if applicable) : (vi) Certificates showing experience claimed : (vii) Certificate or any proof of Indian Nationality : (viii) Institution Leaving Certificate (After qualifying examination) : 4 . (Tick √ against the certificates attached) (i) Post Graduate Degree Passing Certificate : (ii) Statement of marks of Post Graduate Degree exam. (of all years/semesters) : (iii) Statement of marks of Degree exam. Copies of the following certificates should be attached strictly in order given below. Address of Present Employer : __________________________________________ __________________________________________ __________________________________________ __________________________________________ Telephone No.

jobs. Maharashtra State in the matter. I hereby agree to conform to any rules. I fully understand that the offer of a course will be made to me depending on my inter se merit and availability of a seat at the time of scrutiny of my application. acts and laws referred to. I understand that the Principal of the college has the right to expel me from the college for any infringement of the rules of conduct and discipline prescribed by the college or the university or Government and infringement of the undertaking given above. my admission will be cancelled. I am fully aware that I will not be allowed to appear for the examination if I do not attend 75% in theory and practical. and that I shall abide by the decision taken by the College/University of Mumbai/Directorate of Technical Education. when I will actually report to the admission authority according to the schedule of admission. Date: Signature of the Candidate Place Name of the Candidate 5 . fees forfeited and I may be expelled from the college by the Principal.DECLARATION BY THE CANDIDATE The information given by me in this application is true to the best of my knowledge and belief.D. I understand that if any of the statements made by me in the application form or any information supplied by me in connection with my admission is later on at any time found to be false or incorrect. I hereby agree that my admission to the First Year Ph. I am also aware that it is entirely my responsibility to see the notice board / website of the college. I have not been debarred from appearing at any examination held by any Government constituted or statutory examination authority in India. I am aware that college authority will not make any correspondence with me regarding admission. I am also aware that I will not be allowed to appear for the examination if I fail to submit satisfactory assignments. acts and laws enforced by Government and I shall not undertake any act either inside or outside the college which may result in disciplinary action against me under these rules. journals. reports as specified by the University within stipulated time limit. Maharashtra State for any reason.(Technology) in your college is provisional and it is liable to be cancelled if not approved by the University of Mumbai or the Directorate of Technical Education. drawings.

Failure to do so may lead to possible cancellation of admission.(Technology) in Electronics & Telecommunication”.(Technology) Degree. In the event of admission being offered. b) The candidate should have passed the qualifying entrance examination for Ph. who join the institute on the basis of the provisional statement of eligibility from the University of Mumbai.INSTRUCTIONS TO CANDIDATES GENERAL 1. Do not attach originals of certificates.(Technology). Candidates from other Universities. 3. 2. must produce the necessary certificates required by the University for confirmation of eligibility within one month from the date of their admission. 5.D.D. Eligibility: a) As per University of Mumbai rules for Ph. The application must be accompanied by necessary certified true copies/Xerox copies of certificates as mentioned in the application form. The envelope should be super scribed “Application for admission to Ph. 6. Fill in the application form legibly and submit the same at the college Administration Office.D. 4. the candidate will have to produce provisional eligibility certificate from the University of Mumbai before admission is confirmed. Please read the complete application form carefully before filling it up. 6 .