ME ADMISSION 2012-13 Prospectus - K. K. Wagh Education Society

ME ADMISSION 2012-13 Prospectus - K. K. Wagh Education Society ME ADMISSION 2012-13 Prospectus - K. K. Wagh Education Society

22.03.2014 Views

Date of Reporting:_____________ 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: kkwe_office@dataone.in / kkwieer@gmail.com WEBSITE: www.kkwagh.org APPLICATION FOR ADMISSION TO FIRST YEAR MASTER OF ENGINEERING COURSE OF UNIVERSITY OF PUNE FOR THE YEAR 2012-2013 Institute PR No. Course for which admission is sought: M.E. Production M.E. Civil M.E. Electrical (Control System) M.E. Electrical (Power System) { 3 Tick mark in appropriate box} 1.Name of the student: ________________________________________________________________ (In Block Letters) 2. Address Address for Correspondence Permanent Address (Where father/mother Stay) _______________________________________ _______________________________________ _______________________________________ _______________________________________ PIN___________Ph.No. R. __________________ PP. ___________________ Cell ___________________ E-mail ID:________________________________ M.E. Computer M.E. Electronics _______________________________________ _______________________________________ _______________________________________ _______________________________________ PIN___________Ph.No. R. __________________ PP. __________________ Cell __________________ E-mail ID:________________________________ 3. Date of Birth: ________________ Birth Place & District: _________________________ { 3 Tick mark in appropriate box, as applicable} Paste the Photograph inside the box only Don't Staple or Pin the photograph a) Male Female b) GATE Non Gate c) Open SC ST OBC Others (Write Category) d) Are you a Sponsored Candidate Yes/No _______________________ If “Yes” complete item 4, if no skip item 4. 4. Details of Post held ________________________________________________________________ Organization _______________________________________________________________________ Work Experience: Industrial - Year ______________ Month ________________ Teaching - Year ______________ Month ________________ 5. a) Details of Qualifying Examination: Year of Passing Degree Branch University % Of Marks Remarks if any Obtained Obtained

) 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 am aware of the law regarding prohibition of ragging as well as the punishments, and if I am found guilty of offence of ragging and / or abetting ragging, I am liable to be punished appropriately. 3) 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: { 3 Tick mark in appropriate box, as applicable} 1 GATE Score Card 6 Caste Certificate 2 Qualifying Exam Certificate 7 Caste Validity 3 Mark List Of Qualifying 8 Examination 4 Copy of Transfer Certificate 9 5 Sponsorship Certificate Verified by Scrutiny Officer Migration Certificate Work Experience Certificate Sign. of Admission I/c Student Section Admitted / Not Admitted __________________________________________________________________________________ (Official Use) (Students has to fill this column) HOD's Remark: _____________________________ 1000 X 500 X Sign. of HOD 100 X 50 X Provisionally admitted /Not admitted __________ 20 X 10 X 5 X Admission I/C / Student Sect. PRINCIPAL 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

Date of Reporting:_____________<br />

Karmaveer Kakasaheb <strong>Wagh</strong> <strong>Education</strong> <strong>Society</strong>'s<br />

KARMAVEER KAKASAHEB WAGH INSTITUTE OF<br />

ENGINEERING EDUCATION & RESEARCH<br />

Hirabai Haridas Vidyanagari, Amrut Dham, Panchavati, NASHIK-422 003, (Maharashtra).<br />

Ph. No.(0253) 2516671,2512876,Fax-2511962,2621183, 2518870<br />

Mail: kkwe_office@dataone.in / kkwieer@gmail.com WEBSITE: www.kkwagh.org<br />

APPLICATION FOR <strong>ADMISSION</strong> TO FIRST YEAR MASTER OF ENGINEERING<br />

COURSE OF UNIVERSITY OF PUNE FOR THE YEAR <strong>2012</strong>-20<strong>13</strong><br />

Institute PR No.<br />

Course for which admission is sought: M.E. Production M.E. Civil<br />

M.E. Electrical (Control System) M.E. Electrical (Power System)<br />

{ 3 Tick mark in appropriate box}<br />

1.Name of the student: ________________________________________________________________<br />

(In Block Letters)<br />

2. Address<br />

Address for Correspondence<br />

Permanent Address (Where father/mother Stay)<br />

_______________________________________<br />

_______________________________________<br />

_______________________________________<br />

_______________________________________<br />

PIN___________Ph.No. R. __________________<br />

PP. ___________________<br />

Cell ___________________<br />

E-mail ID:________________________________<br />

M.E. Computer<br />

M.E. Electronics<br />

_______________________________________<br />

_______________________________________<br />

_______________________________________<br />

_______________________________________<br />

PIN___________Ph.No. R. __________________<br />

PP. __________________<br />

Cell __________________<br />

E-mail ID:________________________________<br />

3. Date of Birth: ________________ Birth Place & District: _________________________<br />

{ 3 Tick mark in appropriate box, as applicable}<br />

Paste the<br />

Photograph inside<br />

the box only<br />

Don't Staple or Pin<br />

the photograph<br />

a) Male Female<br />

b) GATE Non Gate<br />

c) Open SC ST OBC Others (Write Category)<br />

d) Are you a Sponsored Candidate Yes/No _______________________<br />

If “Yes” complete item 4, if no skip item 4.<br />

4. Details of Post held ________________________________________________________________<br />

Organization _______________________________________________________________________<br />

Work Experience: Industrial - Year ______________ Month ________________<br />

Teaching - Year ______________ Month ________________<br />

5. a) Details of Qualifying Examination:<br />

Year of Passing Degree Branch University % Of Marks Remarks if any<br />

Obtained<br />

Obtained

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