Application Form
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Fields marked with*are mandatory.
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Personal Information
*Name of the applicant  (In case of changed name, write current name)
(First Name) (Middle Name) (Last name)
*Name of the applicant   (as printed on Std. 10 passing certificate)
(First Name) (Middle Name) (Last name)
Previous Name of the applicant  (In case of changed name)
(First Name) (Middle Name) (Last name)
Reason for Name change Marital Status
*Date of Birth *Gender Male Female
Place of Birth Blood Group
(with RH)
Religion *Nationality
Applicant Email ID DTE Application ID
Address for Correspondance  (Local)
*Build. Name/Plot No. Telephone  
Area Name Mobile No.
(without prefix 0)
 
Town/City/Village Email Address
*Country
*State
*District
*Pincode
Tahasil
Permanent address Same as Local Address   Yes No
Permanent Address
*Build. Name/Plot No. Telephone  
Area Name Mobile No.
(without prefix 0)
 
Town/City/Village Email Address
*Country
*State
*District
*Pincode
Legal Reservation System
*Domicile State *Caste Category
*Admission Quota Caste
If Physically Challenged Sub Caste
Father's/Guardian Details
Father's/Guardian Name Mobile Number
(without prefix 0)
 
Occupation of the Father/Guardian Email ID
Annual Income of Father(in Lacs)  (Last Financial Year) Relationship of guardian with applicant
Mother Details
Mother's Name Mobile Number
(without prefix 0)
 
Occupation Email ID
Annual Income of Mother(in Lacs)  (Last Financial Year) Total Parental Income(in Lacs)
Other Information
Mother's Tongue Employment Status
Hobbies/Proficiency and Other Interests Games and Sport Participants Level
(eg. College/State/National/Internationl etc.)
Do you wish to join NCC/NSS YesNo Would you like to apply for hostel YesNo
*Have you enrolled yourself in the Election Voter List? YesNo *Have you link your Nationalised Bank A/c. Number with your Aadhar card YesNo
*Bank Account Number *Aadhar Card Number
Scholarship/Concession Details
Type of Concession applied for
Upload Your Photo/Signature
 
Please upload your photo/signature here.
   
Course Details
*Please select course category option UnderGraduate Post Graduate
Is Lateral Y N
Course Part applied for
   
Education Details Section
Name of Exam Name of Board/University Name of School/College Date of Passing
(DD/MM/YYYY)
Examination Seat No. (Last) Degree/Passing Certificate No. Grade/Total Marks Obtained Out of Qualifying Examination?
Std 10th
*Std 12th
   
Social Reservation  (Check the checkbox whichever is applicable and bring supporting documents.)
&

Attached Documents
List of Document
Document/Certificate Attached Original/Attested
Passing Certificate of Std. 10th & Statement of Marks of Std. 10th Yes No NA Original Attested
Passing Certificate of Std. 12th & Statement of Marks of Std. 12th Yes No NA Original Attested
School/College Leaving certificate Yes No NA Original Attested
Caste Certifcate with Category(If applicable) Yes No NA Original Attested
Caste Validity Certificate(If applicable) Yes No NA Original Attested
Non Creamy Layer Certificate(If applicable) Yes No NA Original Attested
Affidivate for Changed name/Marriage certiifcate/Govt. Gazette Yes No NA Attested
Domicile Certificate Yes No NA Original Attested
Certificate for physically challenged(If applicable) Yes No NA Original Attested
Nationality certificate Yes No NA Original Attested
Migration certificate (other than R.T.M. Nagpur University) (if applicable) Yes No NA Original Attested
Eligibility Certificate (other than M.S. Board) (if applicable) Yes No NA Original Attested
CET/JEE (Mains Score card) Yes No NA Original Attested
Gap Certificate(If applicable) Yes No NA Original Attested
Parent Income Certificate (If applicable) Yes No NA Original Attested
Sponsorship Certificate (If applicable) Yes No NA Original Attested
Experience Certificate (If applicable) Yes No NA Original Attested
College Allotment Letter Yes No NA Original Attested
Diploma(Polytech) Mark Sheet Yes No NA Original Attested
Diploma(Polytech) Certificate Yes No NA Original Attested
Degree B.E. / B.Tech Certificate Yes No NA Original Attested
Statetement of marks of B.E. / B.Tech Graduation (Marksheets) Yes No NA Original Attested
Any Other Yes No NA Original Attested
Any Other Yes No NA Original Attested


Upload Your Documents
 
Please upload following documents here.
(Passing Certificate of Std. 10th & Statement of Marks of Std. 10th, Passing Certificate of Std. 12th & Statement of Marks of Std. 12th,MT-CET/JEE score card, School/College Leaving certificate,Caste Certifcate with Category, Caste Validity Certificate)
 
Please upload following documents here.
(Non Creamy Layer Certificate, Affidivate for Changed name/Marriage certiifcate/Govt. Gazette, Domicile Certificate, Certificate for physically challenged, Nationality certificate, Migration certificate)
 
Please upload following documents here.
(Eligibility Certificate, CET/JEE (Mains Score card), Gap Certificate, Parent Income Certificate, Sponsorship Certificate, Experience Certificate, College Allotment Letter, Diploma(Polytech) Mark Sheet, Diploma(Polytech) Certificate, Degree B.E. / B.Tech Certificate, Statetement of marks of B.E. / B.Tech Graduation (Marksheets), Any other Certificate)


Declaration by Student

I hereby declare that, I have read the rules related to admission and the information filled in by me in this form is accurate and true to the best of my knowledge. I will be responsible for any discrepancy, arising out of the form signed by me and undertake that, in absence of any document the final admission will not be granted and / or admission will stand cancelled.

      Place : 
       Date : 


Declaration by Guardian

I have permitted my son / daughter / ward to join your college. The information supplied by him / her is correct to the best of my knowledge. I have acquainted myself with the rules and fees, dues to my son / daughter / ward and I assure that my ward will adhere to the college rules and fees.

      Place: 
       Date: 


     I Agree
   
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