ALL SAINTS' COLLEGE OF TECHOLOGY

(KURWAI EDUCATION SOCIETY)

Approved By - ALL INDIA COUNCIL FOR TECHNICAL EDUCATION, NEW DELHI

& GOVERNMENT OF MADHYA PRADESH

Affiliated To - RAJIV GANDHI PROUDYOGIKI VISHWAVIDYALAYA, M.P., BHOPAL

FACING INTERNATIONAL AIRPORT, GANDHI NAGAR BHOPAL–462036 (MP)

ADMISSION FORM

Course- M.Tech BE Branch ______Academic Year 2015-2016

1. (a)(I) Candidate’s Full Name in Block Letters as given in X Mark sheet :

0

(II) Student’s Mobile No.:

(III) Date of Birth:In Figure : DD M MY Y Y Y

In Words : ______

(IV) Father’s Name:

0

(V) Father’s Mobile No.:

(VI)Mother’s Name:

0

(VII) Mother’s Mobile No.:

(VIII) Place of Birth :______District ______State______

(b) Occupation of Father: ______

(c) Permanent Address: ______

______

CITY :______Pin ______State:______

Telephone No.: (With STD Code ) ______

(d) Present Address: ______

______

CITY :______Pin ______State:______

Telephone No.: (With STD Code ) ______

E-mail Address:______

(e) Religion :______

(f) Category : General SC ST OBC

  1. Local Guardian Name (if any): ______

Occupation: ______

Relationship: ______

Residential Address : ______

______

Telephone & Mobile Number : ______

  1. Details of Qualifying Examination Passed on the basis of which admission is sought.

(See Eligibility rules)JEE / 12th

JEE / 12th Roll No. : ______Total Marks Obtained: ______

DETAILS OF 12th EXAMINATION

S.No / SUBJECT / Maximum Marks / Obtain Marks / Grade / BOARD
1 / HINDI / URDU
2 / ENGLISH
3 / PHYSICS
4 / CHEMISTRY
5 / MATHS
TOTAL:

12th Percentage ______PCM Percentage ______

UNDERTAKING

I am aware that ragging in any form is banned in ASCT, Bhopal and do hereby undertake not to indulge in any form of ragging during the course of my study at ASCT, Bhopal

Signature of the Candidate

I am aware that ragging in any form is banned in ASCT, Bhopal and that I agree to abide by the punishment meted out to my ward in case he/she is found guilty of ragging.

Signature of Parent/Guardian

Declaration by the Candidate

I declare that:

(a)The information given in this application form is correct and if I am found guilty of giving wrong information, I shall be disqualified from admission.

(b) I promise to abide by the rules and regulations, statutes and ordinances of All Saints’ College of Technology/Concerned University, any changes incorporated therein from Time-to-time and to maintain the discipline of the college.

Residence Place:______

Date :_____/ ______/ ______

Signature of the Candidate

ALL SAINTS' COLLEGE OF ENGINEERING

(KURWAI EDUCATION SOCIETY)

Approved By - ALL INDIA COUNCIL FOR TECHNICAL EDUCATION, NEW DELHI

& GOVERNMENT OF MADHYA PRADESH

Affiliated To - RAJIV GANDHI PROUDYOGIKI VISHWAVIDYALAYA, M.P., BHOPAL

PIPALNER, GANDHI NAGAR BHOPAL–462036 (MP)

ADMISSION FORM

Course- M.Tech BE Branch ______Academic Year 2015-2016

1. (a)(I) Candidate’s Full Name in Block Letters as given in X Mark sheet :

0

(II) Student’s Mobile No.:

(III) Date of Birth:In Figure : DD M MY Y Y Y

In Words : ______

(IV) Father’s Name:

0

(V) Father’s Mobile No.:

(VI)Mother’s Name:

0

(VII) Mother’s Mobile No.:

(VIII) Place of Birth :______District ______State______

(g) Occupation of Father: ______

(h) Permanent Address: ______

______

CITY :______Pin ______State:______

Telephone No.: (With STD Code ) ______

(i) Present Address: ______

______

CITY :______Pin ______State:______

Telephone No.: (With STD Code ) ______

E-mail Address:______

(j) Religion :______

(k) Category : General SC ST OBC

  1. Local Guardian Name (if any): ______

Occupation: ______

Relationship: ______

Residential Address : ______

______

Telephone & Mobile Number : ______

  1. Details of Qualifying Examination Passed on the basis of which admission is sought.

(See Eligibility rules)JEE / 12th

JEE / 12th Roll No. : ______Total Marks Obtained: ______

DETAILS OF 12th EXAMINATION

S.No / SUBJECT / Maximum Marks / Obtain Marks / Grade / BOARD
1 / HINDI / URDU
2 / ENGLISH
3 / PHYSICS
4 / CHEMISTRY
5 / MATHS
TOTAL:

12th Percentage ______PCM Percentage ______

UNDERTAKING

I am aware that ragging in any form is banned in ASCT, Bhopal and do hereby undertake not to indulge in any form of ragging during the course of my study at ASCT, Bhopal

Signature of the Candidate

I am aware that ragging in any form is banned in ASCT, Bhopal and that I agree to abide by the punishment meted out to my ward in case he/she is found guilty of ragging.

Signature of Parent/Guardian

Declaration by the Candidate

I declare that:

(a)The information given in this application form is correct and if I am found guilty of giving wrong information, I shall be disqualified from admission.

(c) I promise to abide by the rules and regulations, statutes and ordinances of All Saints’ College of Technology/Concerned University, any changes incorporated therein from Time-to-time and to maintain the discipline of the college.

Residence Place:______

Date :_____/ ______/ ______

Signature of the Candidate

ADMISSION CELL