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Application For Part Time M.tech

This document appears to be an application form for admission to a part-time M.Tech program. It requests information such as the applicant's name, date of birth, gender, contact details, academic qualifications including marks/grades from Class X onwards, GATE/PGECET exam scores if applicable, and any relevant work experience. The applicant is required to sign declaring that the information provided is true and agreeing to abide by the admission procedures and policies.

Uploaded by

Bhanu Kanatala
Copyright
© Attribution Non-Commercial (BY-NC)
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32 views2 pages

Application For Part Time M.tech

This document appears to be an application form for admission to a part-time M.Tech program. It requests information such as the applicant's name, date of birth, gender, contact details, academic qualifications including marks/grades from Class X onwards, GATE/PGECET exam scores if applicable, and any relevant work experience. The applicant is required to sign declaring that the information provided is true and agreeing to abide by the admission procedures and policies.

Uploaded by

Bhanu Kanatala
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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APPLlCATlON NUMBER

READ DETAlLED lN5TRUCTlON5 GlVEN 5EPARATELY


BEFORE FlLLlNG THE APPLlCATlON FORM
Paste your recent
passport slze co|our
pbotograpb not o|der
tban 3 montbs. Do not
pln or stap|e
PHOTOGRAPH
5lGNATURE OF APPLlCANT
APPLlCATlON FORM
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NAML OP THL APPL|CANT (AS |T APPLAPS |N CLASS X OP LQU|vALLNT MAPKS CAPD)
DATL OP 8|PTH SLX (T|CK)
MALL DATL MONTH YLAP PLMALL
COUPSL CHO|CL
CHO|CL 1 CHO|CL 2 CHO|CL 3
NAML OP THL PAPLNT / GUAPD|AN
ADDPLSS POP COPPLSPONDLNCL
DOOP / HOUSL No.
STPLLT NAML
PLL|G|ON
CATLGOPY (T|CK)
8C SC ST Otbers PH
LMA|L |D
P|N CODL STATL D|STP|CT
LOCAL|TY / MANDAL
TLLLPHONL NUM8LP MO8|LL NUM8LP STD CODL
TOWN / C|TY
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APPLlCATlON FEE DETAlL5 : CASH : OR DD :
PAYMENT MODE NUMBER DATE AMOUNT l55UlNG BANK NAME
DD DETAlL5
BRANCH
CA5H RECElVED BY : Mr./Ms. .............................................. Slgnature ...................................... P|ace .........................................................
5lGNATURE OF APPLlCANT
ACADEMlC DETAlL5
1. X C|ass
State :
Year o| Pass : 8oard :
Year o| Pass :
Unlverslty :
Co||ege :
YEAR / 5EME5TER MAXlMUM MARK5 MARK5 OBTAlNED
TOTAL
MONTH & YEAR
P|ace : ............................
Date : ............................
DECLARATlON: | bereby dec|are tbat a|| tbe partlcu|ars stated ln tbls app|lcatlon are true to tbe best o| my know|edge and be|le|. | bave read and
understood a|| provlslons o| tbe admlsslon procedure and agree to ablde by tbem. |n tbe event o| submlsslon o| |raudu|ent, lncorrect or untrue
ln|ormatlon or suppresslon or dlstortlon o| any |act |lke educatlona| qua|l|lcatlon, marks etc., | understand tbat my admlsslon / degree ls |lab|e |or
cance||atlon. Purtber | understand tbat my admlsslon ls pure|y provlslona| subject totbe |u||l|ment o| tbe e|lglbl|lty crlterla.
5lGNATURE OF PARENT/ GUARDlAN
5ignature of officia| with sea|
vlgnan Unlverslty / Scboo| / Co||ege / Lngg. Co||ege
2. 10+2 or equiva|ent Group : MPC : 8lPC :
Marks : TOTAL MAPKS MAPKS O8TA|NLD % OP MAPKS
State :
Year o| Pass : 8oard :
Marks : TOTAL MAPKS MAPKS O8TA|NLD % OP MAPKS
3. Graduation :
Marks Detal|s : %OF MARK5
| YLAP / | SLM
| YLAP / || SLM
|| YLAP / ||| SLM
|| YLAP / |v SLM
||| YLAP / v SLM
||| YLAP / v| SLM
|v YLAP / v|| SLM
|v YLAP / v||| SLM
GATE / PGECET / OTHER TE5T 5CORE
TE5T NAME TE5T DATE FORM NO 5CORE
ACKNOWLEDGMENT
Name o| tbe App|lcant : ..................................................................................... S/o / D/o ...........................................................................................
Pecelved app|lcatlon |or Admlsslon to M.Tech (Macblne Deslgn / CAD-CAM / Communlcatlon & Slgna| Processlon / Lmbedded Systems / Power L|ectronlcs & Drlves / CSL
/vLS|).
P
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WORK EXPERlENCE
DE5lGNATlON WORKlNG lN5TlTUTlON & PLACE
FROM TO
DURATlON OF WORKlNG

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