Admission Form

MODERN COLLEGE OF ENGINEERING

1186 A, Shivajinagar, Off. J.M.Road, Pune-411 005
Tel.020 - 25533638
Affiliated to University of Pune & Recognised by AICTE(Govt. of India)

Sr.No.	Course	Course Preference No
1	Mechanical Engineering
2	Computer Engineering
3	Electronics & Telecommunication
4	Electrical Engineering

For Office Use Only

Serial No

Photograph

Seat Category :

AIEEE

MH_CET

MANAGEMENT

NRI

J & K

1.Name of the Candidate :
	Surname First Name Middle Name
2.Address :

City:
PinCode:
Tel No.

3.Higher Secondary Certificate Exam(Std XII):

4.Entrance Marks:

Name of Board :

Name of the School/College :

5.Secondary School Certificate Exam(Std X):

Name of Board :

Name of the School/College :

6.Diploma in Engineering:

Marks	Out Of	Percentage

Name of Board :

Name of the School/College :

10.Tick at appropriate option:
(a)Do you belong to any of the Backward Classes?	Yes	No
	a)Class:	ST SC VJ DT NT1 NT2 NT3 OBC
	Religion: Caste:
(b)Do you belong to Physically Handicapped Category?	Yes	No

11.I hereby declare that
	(a)I have not been detained from appearing at any examination held by any Governament Controlled or Statutory Examination in India. (b)I have given choice of branches and I do not wish to give any other choice and that I shall not claim on any other branch than what is mentioned in preference code. (c)The information given above is true to the best of my knowledge and belief.

12.I hereby undertake that
	(a)In ____, I will abide by the rules and regulations in force at present or that may hereafter be made by the College and so long as I am student of the College. I will do nothing either inside or outside the College that will ________. (b)On ___ for Admission to the Engineering College, I will sign the requisite bond as prescribed by the management.
	Date:
	Place:	Signature of the Candidate

13.Declaration to besigned by candidates belonging to Backward Classes.
	I understand that the admission given to me against quota for reserved category is purely provisional and will be cancelled if my caste certificate is rejected by the Director of Social Welfare, Maharashtra State.
	Date:
	Place:	Signature of the Candidate

14.Declaration to be signed by candidate admitted by.
	I understand that the admission given to me is purely provisional and will be cancelled if not approved either by management of the College / Directorate of Technical Education / University of Pune.
	Date:
	Place:	Signature of the Candidate

15.Declaration to be signed by candidate admitted by.
	I understand that the admission given to me is purely provisional and will be cancelled if not approved either by management of the College / Directorate of Technical Education / University of Pune.
	Date:
	Place:	Signature of the Candidate

16.Declaration to be signed by candidate's father/guardian.
	I do hereby declare that 1)The particulars furnished by my son/daughter/ward in this application form are signed by me and are correct to the best of my knowledge.
	Date:
	Place:	Signature of the Candidate

Note:
	Attested true copies of the following certificates are to be attached along with the application. 1.Statements of marks in detail of ____ i]S.S.C ii]H.S.C. iii]MHT-CET - 2006 iv]AIEEE-2006 2.Institute/College Leaving Certificate (H.S.C.) 3.Caste Certificate by Executive Magistrate of Maharashtra State. 4.Caste Verify Certificate issued by the Divisional Caste Certificate Scrutiny Committee _____ office or caste scrutiny Controller, Director of Social Welfare, Maharashtra State ___ (in case of backward classes only). 5.Migration Certificate if applicable. 6.Gap Certificate for diploma students if applicable.