Form No.
Academic Year
______Part
Scheme

Application Form (To be filled with blue/black point pen)For official use only.

Govt. Engineering CollegeBikaner

[An Autonomous Institution of Government of Rajasthan]

/ Course
B.C.A. / M.Sc.(C.S.) / M.C.A.

To,

Principal

Govt. Engineering College, Bikaner

Sir, P h o t o g r a p h

I ………………………………..…….…………S/o,D/o …………….…...………….……….……… am

submitting an application for seeking admission in the ______Courseconducted

by Department of Computer Application of your college.Following details are being

supplied to you for your kind perusal.

To be filled in capital letters only.STUDENT PROFILE

1. NAME

2. FATHER’S NAME{do not write Mr./Sh. Etc before name}

3. FATHER’S OCCUPATION Family Annual Income

4. MOTHER’S NAME{do not write Mrs./Smt. Etc before name}

5. DATE OF BIRTH 6. GENDER 7. CATEGORY{ Mark  sign at appropriate box not}

DD / MM / YY / Male / Female
GEN / SC / ST / OBC / PH / OTHERS

8. ADDRESS{ Please do not repeat parents name }

Local Address
Permanent Address

9. CONTACT NUMBERS{ Home Land line numberwith STD code} MOBILE NO.(Self)

Alternate contactnumber{ Father / Mother} Email Address(if any)

10. EDUCATIONAL QUALIFICATION

STANDARD / YEAR / % / DIVISION / MODE / SCHOOL / BOARD/UNIV. / SUBJECT
10th
12th
Graduation
Any Others

Mode : Regular or Private.

11. Other Achivments (…………………………………………………………………………………………………. )

Page 1 of 2

12. PLEASE FILL THE FOLLOWING COLUMN

S.NO. / Particular / Yes / No.
1. / Do you require hostel of the college
2. / Have you been punished before it
3. / Have you been restricted for the examination
4. / Have you been declared physical handicapped / blind / physically disable etc.
5. / Do you require college transportation

Please enclose the concerned document.

13. RULES / REGULATION

Students will have to secure the minimum attendance prescribed by the Maharaja Ganga Singh University (BCA,BBA,M.Sc.(IT)) / RajasthanTechnicalUniversity, Kota (MCA).

Information and Documentation submitted by the student should be authentic.

Testimony of the same is essentially required and should be enclosed along with this application form.

In the case of reserved category the candidate will have to submit required documents.

Student will have to follow the dress code / code of conduct prescribed by the college.

If the candidate avails the hostel facility / college transport he/she will have to pay accordingly in addition to the college fee.

All the rules and regulation prescribed by the Maharaja Ganga Singh University (BCA, BBA, M.Sc.(IT)) and RajasthanTechnicalUniversity, Kota(MCA) Course are expected to be followed by the students.

14. DECLARATION

I………………………………………………..have read all the rules and regulation mentioned above. All the information and data given by me are accurate. Misinformation in any form will be treated as cancellation of the candidature ship.A

Date …./…./……..

Place ………………………… (Signature Candidate) (Signature Parent)

FOR OFFICE USE ONLY

Department of Computer Application

Declaration of submission
Mr./Miss…………………………………………has submitted an application for seeking admission in MCA Course-2009-12. Candidate has submitted following documentation along with this application form-
10th Mark sheet / Original / Photo copy
12th Mark sheet / Original / Photo copy
Graduation / Original / Photo copy
Domicile certificate / Original / Photo copy
Cast certificate / Original / Photo copy
Migration / Original / Photo copy
Mode of payment / Draft / Cheque / Cash / Original / TC & CC
Any other (please specify)
Candidate is having ………..rank in order to merit of total applications received.
Date …../…../……… Checked by:…………………………….. (Signature Proctor)

For Account Section

Installment No. / First / Installment No. / Second
Received Date / Received Date
Challan No. / Challan No.
D.D. Detail / No. / D.D. Detail / No.
Bank. / Bank.
Cash (please submit the bank receipt) / Cash (please submit the bank receipt)