ADMISSION FORM

For Admission in Gian Jyoti Institute of Engineering & Technology

For Admission in Gian Jyoti School of Management

Session: 2012 – 2013

B.Tech. (LEET) B.Tech MBA

(To be filled by the Candidate. No column should be left blank)

1. Name of the Candidate (BLOCK LETTERS): …………….………………………………………………………………………………………………….

2. Father’s Name: …………………………………………………………………………………………………………………………………………………………

3. Occupation: …………………………………………………… Total Income (per annum) : …………………………………………………………..

4. Mother’s Name: …………………………………………………………………………………………………………………………………………………………

5. Date of Birth: ………………………………………………………………………………………………………………………………………………………………

6. Domicile: …………………………………………. (Mention State)

7. Gender: Male Female

8. Category: General SC ST OBC Others

9. Details of Qualifying Examination:

Exam Passed / School /
College / Board /
Univ. / Period /
Session / Main
Subjects / Marks Obtained
/ Max. Marks / Percentage
(%age)
10th Class
10+2 Class
Graduation
Any Other

10. MET-2011 Roll No.(For MBA only) ……………………… Rank ………………………………

11.  AIEEE-2011 Roll No. ………………………………… Rank ………………………………

12.  Any other Test Roll No. ………………………………… Rank ………………………………

14. B.Tech aspirants, please fill in the table below:

Course Name / Order of Preference (1 to 5)
B.Tech- Electronics & Communication Engg. (ECE)
B.Tech- Computer Science & Engg. (CSE)
B.Tech- Electrical Engg. (EE)
B.Tech- Mechanical Engg. (ME)
B.Tech- Civil Engg. (CE)

15. Requirement of Hostel / Bus Facility (Chandigarh / Ambala / Panchkula / Mohali / Rajpura / Patiala)

Hostel: Yes / No Bus Facility: Yes / No

16. Correspondence Address: …………………………………………………………………………………………………………

City: ………………………… Pin Code: ………………… State: ………………… E-mail ID: ………….…………………

Student Mobile No. : ………………… Parent Mobile No. : ………………… Resi. Phone with STD Code ………………

17. Admission Through: PTU Counseling Management

18. Do you have any serious ailment? If yes, please specify______

Note: Please attach the photo copies of:

Sr. No. / Document / Tick Yes/No / Date of Submission of Document / Remarks (if any)
1 / PTU Allotment Letter
2 / AIEEE Admit Card
3 / AIEEE Score Card
4 / 10th Detailed Marks Sheet
5 / 10th Passing Certificates
6 / 10+2 DMC / Diploma DMC
7 / 10+2 Passing Certificate
8 / Migration Certificates
9 / Character Certificates
10 / Residence Proof ( Domicile)
11 / Medical Certificate ( PTU Format)
12 / Gap Year Certificate (if any)

Whether Physics and Math’s as compulsory subject yes or not: ______

If yes, then fill the percentage ______

Name & Signature (Document Verification handled by): ______Date: ______

Undertaking

I ______s/o/D/o______undertake that I will provide the institute all the mentioned documents by date______Failing which; the institute reserves the right to cancel my admission and to debar my candidature from B.Tech university examinations.

Signature Of parents/Guardian Signature of candidate

For Office Use Only

Total admission fee to be paid: Scholarship (if any):

Balance Admission Fee (Total fee- Scholarship):

Please receive amount of Rs______admission fee Rs______Hostel fee and Rs______

Transportation fee.

Name of Admission Coordinator Signature of Admission Coordinator

For Accounts Section

Total Admission Fee Paid (by student):

Registration fee paid ______vide receipt no.______on date______

Pending Fee ______Due Date______

Hostel Fee ______Transportation Fee______

Signature of Accounts In-Charge