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M.E. Applicatino Form

This document is an application form for admission to a Master of Engineering program at Karmaveer Kakasaheb Wagh Institute of Engineering Education & Research for the 2009-2010 year. It requests information such as the applicant's name, address, date of birth, gender, caste or tribe, academic qualifications and work experience. The applicant must also provide details of their GATE score if applicable and declare that they will adhere to the institute's rules if admitted. Required documents to be enclosed with the application are listed.

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Omkar Shete
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188 views2 pages

M.E. Applicatino Form

This document is an application form for admission to a Master of Engineering program at Karmaveer Kakasaheb Wagh Institute of Engineering Education & Research for the 2009-2010 year. It requests information such as the applicant's name, address, date of birth, gender, caste or tribe, academic qualifications and work experience. The applicant must also provide details of their GATE score if applicable and declare that they will adhere to the institute's rules if admitted. Required documents to be enclosed with the application are listed.

Uploaded by

Omkar Shete
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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Karmaveer Kakasaheb Wagh Education Society’s

KARMAVEER KAKASAHEB WAGH INSTITUTE OF


ENGINEERING EDUCATION & RESEARCH
Hirabai Haridas Vidyanagari, Amrut Dham, Panchavati, NASHIK-422 003, (Maharashtra).
Ph. No.(0253) 2516671,2512876,Fax-2511962,2621183, 2518870
Mail: kkwcoe_nsk@sancharnet.in, kkwe_office@dataone.in WEBSITE: www.kkwagh.org

APPLICATION FOR ADMISSION TO FIRST YEAR MASTER OF ENGINEERING


COURSE OF UNIVERSITY OF PUNE FOR THE YEAR 2009-2010 Paste the
Date of Reporting:_____________ Photograph inside
the box only
Institute PR No.
Don’t Staple or Pin
Course for which admission is sought: ME Production (Manufacturing & Automation)/
the photograph
M.E. Civil(Structure) / M.E. Electrical (Control System) Engineering
{√ Tick mark in appropriate box}

1. Name of the student: ___________________________________________________________________

2. Address
Correspondence Address Permanent Address (Where father/mother Stay)
____________________________________________ ________________________________________
____________________________________________ ________________________________________
____________________________________________ ________________________________________
____________________________________________ ________________________________________
PIN___________Ph.No. R. _____________________ PIN_____________ Ph.No. R- _______________
PP. _____________________ PP. ________________
Mob. _____________________ Mob. _________________
E-mail ID: E-mail ID:

3. Date of Birth: ________________Age: ________ Birth Place & District: _________________________


{√ Tick mark in appropriate box, as applicable}

a) Male Female

b) Open SC ST OBC Others (Write Category)

c) GATE Non GATE

d) Are you a Sponsored Candidate Yes/No _______________________


If “Yes”
4. Details of Post held _____________________________________________________________________
Organization ___________________________________________________________________________
Work Experience: Industrial - Year ______________ Month ________________
Teaching - Year ______________ Month ________________

5. a) Details of Qualifying Examination:


Degree % Of Marks
Year of Passing Branch University Remarks if any
Obtained Obtained
b) Details of GATE Score on the basis of which admission is being sought.
Year ____________ Branch ___________ Percentile ____________

(Student to keep three sets of attested Xerox with them for subsequent use)

DECLARATION
1) I hereby declare that I have carefully read and understood the instruction and particulars supplied to me
by the Institute and all entries filled by me in this form are true to the best of my knowledge and belief.

2) I will strictly adhere to the rules, regulations and discipline of the Institute
Place: NASHIK
Date: ____________ Signature of the student

Attested copies of certificate Enclosed:


{√ Tick mark in appropriate box, as applicable}

1. Qualifying Exam Certificate 5. Caste Certificate

2. GATE Score Card 6. Migration Certificate

3. Mark List Of Qualifying 7. Work Experience Certificate


Examination
4. Copy of Transfer Certificate 8. Sponsorship Certificate

Verified by
Scrutiny Officer

Sign. of Admission I/c Student Section Admitted / Not Admitted


_______________________________________________________________________________________
(Official Use) (Students has to fill this column)
HOD’s Remark: _____________________________
1000 X
Sign. of HOD 500 X
100 X
Provisionally admitted /Not admitted __________ 50 X
20 X
10 X
Admission I/C / Student Sect. PRINCIPAL 5 X
2 X
1 X
Accounts Remarks –
Total Rs.
Fees Paid Rs._____________
Fee Dues: ____________ D.D. No. ______________ Date: _____________
Receipt No. ____________ Date ___________ Bank: ______________________ For Rs. _____________
D.D. No. ______________ Date: ___________ Bank: ______________________ For Rs. _____________

Cashier’s Signature

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