MODI INSTITUTE OF TECHNOLOGY, KOTA

Rawatbhata Road, Nayagaon, Kota-324001

Admission form (Management Seat)

Session 200______- 200______

B.E.First Year

1.Name of Applicant, Mr. / Ms.:______

(In Capital Letter)

2.Father’s / Guardian’s name:______

3.Local Guardian’s name:______

(If father or Guardian not in Kota)

4.Date of Birth: DD ______MM______YY______

5.Place of BirthCity/Village______State______

6.Nationality:______Religion______

7.Whether belongs to (SC/ST/OBC):______Caste ______

8.Present Address:______

______

Tele______Pin______

9.Permanent Address:______

______

Tele______Pin______

10. Preperence of Branch:(1)______(2)______(3)______

11.Category

Ex.Ser. / D.K. / P.H / SC / ST / OBC / General / Girls

12.Status in AIEEE/RPETEAP

Rank in RPETEAP ______Rank in AIEEE______

13.Particulars of Previous Academic Records:

Class / Name of
School/Inst. / Board/
University / Year of passing / No. of Attempts / Aggregate %age PCM
Senior
Secondary

I declare that all information mentioned above are correct to the best of my knowledge and nothing has been concealed and no case of criminal offence or moral turpitude is pending against me in any court of law, also no FIR has been launched against me by the University / Principal or any other authority.

Date:(Signature of Applicant)

Admission / Provisional Admission Granted to B.E. First Year ______

Signature Incharge

Admission Criteria for Admission against Management Quota

01.Senior secondary Examination (XII) ClearPass (Without Supplementary / Compartment)

(Submit Original Mark sheet and 2 attested photocopies)

02.A Candidate should not be less then 16 years of age on 01.10.2007and not more than 23 Years on 01.10.2007. i.e. candidate should born before 20.10.1984 and Not born later than 01.10.1992 (Upper age limit is relax able up to 3 Years in case of candidate belongs to SC/ST) (Submit Original Mark sheet / Certificate of Secondary Examination )

03.Medical Fitness Certificate attested by the Government Doctor (Performa available on the RPETEAP07 website.

04.Transfer certificate of Last Studying Educational Institution.

05.Migration Certificate

(In case the candidate not passed the Senior secondary (XII) from Board of Secondary Education Rajasthan, Ajmer)

06Photocopy of the mark sheet of RPETEAP 07/ AIEEE07

07 Should be pass in 10+2 with Physics & Mathematics as Compulsory

subjects along with any one of the following subjects:

1. Chemistry 2. Bio Technology

  1. Computer science

08.Proof of Identify: Photocopy of any one of the following:-

PAN / Ration Card / Electricity Bill / Driving License / Election Card.

Certificate of Medical Fitness

This certificate must be from the Medical Officer of the Government of Rajasthan of the rank of CMHO / DMHO of District Government Hospital / Medical Jurist / Superintendent of Medical College Hospital in Rajasthan / Incharge of any GovernmentHospital / Dispensary of Rajasthan and must be brought by the candidate at the time of admission.

1.RPETEAP Roll No.:______

2.Name of Candidate:______

3.Father’s Name:______

4.Height:______

5.Weight:______

6.Identification Mark:______

7.Chest Measurement:______

8.Heart and Lungs:______

9.Piles Hydrocele, Hernia etc:______

10.Vision:______Candidate should affix his/

11.Color Blindness:______her passport size photo to

12.Hearing:______be attested by the signing

13.Speech:______Medical Officer

  1. Whether Physically Handicapped ______

Yes / No

Certified that the candidate possesses the medical standards given below and is medically fit for the Engineering Profession.

Place: ______

Date : ______

Signature and designation with seal of the

Authorized Medical Officer

Medical Standards

1.Height:Not less than 1.6 m for male candidate and not less than 1.4 m for female candidates

2.Weight:Not less than 41 kg approximately for male candidates and 37 kg approximately for female candidates.

3.Chest Measurement:Not less than 69 cm with satisfactory limits of the expansion and contraction (for male candidates only)

4.Heart and Lungs:No abnormality

5.Hernia Hydrocle, piles etc:Presence of any of these will be a temporary disqualification tobe rectified before joining the courses of study.

6.Vision:Normal. Where defective, it must be corrected to 6/9 in the better eye and 6/12 in the worse eye. Eyes should be free from congenital and other disease. In case of admission of Mining Engineering courses, the candidates must be free from color blindness (inability to distinguish between principal color) also

7.Hearing:Normal. Where defective, it must be corrected

8.Speech:Normal