INSTRUCTIONS FOR FILLING APPLICATION - ITM University

11. ADDRESS FOR CORRESPONDENCE: Write the complete postal address including PIN CODE to which communication is to besent. Also write the telephone number with STD CODE and E-mail address, if any.For example, address:2 4 , C I T Y C E N T E R N E A RP A T E L N A G A R G W A L I O R12. CITY: Fill in your city’s name. For example, the city ‘GWALIOR’ should be written as:G W A L I O R13. STATE: Refer to the table given below for state codes. For example, the state MADHYA PRADESH. STATE 2 5STATE CODE STATE CODEAndhra Pradesh 11 Mizoram 29Arunachal Pradesh 12 Nagaland 30Assam 13 Orissa 31Bihar 14 Punjab 32Chhattisgarh 15 Rajasthan 33Delhi 16 Sikkim 34Goa 17 Tamil Nadu 35Gujarat 18 Tripura 36Haryana 19 Uttar Pradesh 37Himachal Pradesh 20 Uttaranchal 38Jammu and Kashmir 21 West Bengal 39Jharkhand 22 Andaman and Nicobar Islands (UT) 40Karnataka 23 Chandigarh (UT) 41Kerala 24 Dadra and Nagar Haveli (UT) 42Madhya Pradesh 25 Daman and Diu (UT) 43Maharashtra 26 Lakshadweep (UT) 44Manipur 27 Pondicherry (UT) 45Meghalaya 2814. PIN CODE: Fill up with the appropriate 6-digit PINCODE. For example, the PINCODE ‘474001’ should be written as:4 7 4 0 0 115. STD CODE: Fill up the STD CODE in the boxes provided. Use zero when prefixed to the STD code. For example, the STD codefor GWALIOR should be written as:0 7 5 116. TELEPHONE NUMBER: Fill up your phone number in the boxes provided. For example, the telephone number 54032613should be written as:5 4 0 3 2 6 1 314

17. MOBILE NUMBER: Fill up your mobile in the boxes provided and do not prefix ‘0’ or leave any blank between numbers. For example,the mobile number 6024563240.6 0 2 4 5 6 3 2 4 018. EMAIL ADDRESS: Fill up the email id in CAPITAL Letters without blank spaces. For example, the e-mail id ‘ajaysharma@gmail.com’should be written as:A J A Y S H A R M A @ G M A I L . C O M19. PARENT’S INCOME (Rs.): For example, if the parent’s income is 2,40,000/- tick as:Below 60,000 60,000 to 2,40,000 2,40,000 to 5,00,000 Above 5,00,00020. PARENT/GUARDIAN OCCUPATION: Write the occupation of your parent. For example, if your parent is a Doctor, it should bewritten as:1 2OCCUPATION CODE OCCUPATION CODEPROFESSIONGOVERNMENT SERVICESEngineer 11 I.A.S 24Doctor 12 I.P.S 25Chartered Accountant 13 I.F.S 26Lawyer 14 SERVICE CATEGORYAgriculturalist 15 Army 27Artist 16 Air Force 28Software 17 Navy 29Consultant 18 Police 30Teacher 19 Judiciary 31Self Employed 20 Other Govt. Services 32Other Private Sector 21 OTHER PUBLIC SERVICE through ELECTION MODE 33Business 22Others 2321. HOSTEL REQUIRED: tick ‘yes’ if you required an on campus hostel accommodation.A. YES NO B. Hostel room preference C. food preference D. comfort preferenceA B A B A BFor details see below:B. Hostel room preferenceCode Specifications Tariff (INR per annum)A Twin sharing bedrooms with common toilets Rs. 30,000/-B Studio Apartment – Single bed room + Pantry +Exclusive balcony + Common toilets for 02 persons Rs. 65,000/-15

C. food Preference:Code Specifications Tariff (INR per annum)A Vegetarian Rs.30,000B Non-vegetarian Rs.45,000D. Comfort Preference:A Air Cooling System per room Rs. 5,000 (P.A.)+ Electricity charges as per actualsB Air-Conditioning System per room Rs. 10,000 (P.A.)+ Electricity charges as per actualsUse of Air Conditioners and Coolers will be guided by Fair Usage Policy (FUP).Fair Usage Policy (FUP) - Air Cooler and Air Conditioners can only be operated between evening 8.00 pm to morning 6.00 am.Facilities for all hostlers:-Gym and Health Club, Power, Security, Club Membership, Swimming Pool Membership (under construction),College Magazine, Ambulance Services (24x7), Medical First Aid.22. DETAILS Xth and XIIth STANDARD: Write the School/College, Board/ University Code, Month and year of Passing and aggregatepercentage mark obtained in Xth standard/aggregate marks obtained in PCM (Physics-Chemistry-Maths)/PCB (Physics-Chemistry-Biology) in XIIth Std. or equivalent examination. In case the XIIth result has been published, the marks obtained should be send on-lineand mark sheet should be produced at the time of counseling. (Refer the below, an example for Board/University code)For example, if you are from R.B.S School and passing XIIth Standard from Madhya Pradesh Board of Secondary Education in May,2011 with Xth standard score of 90%, it should be written as:SCHOOL EXAM SCHOOL BOARD (CODE) MONTH/YEAR % MARKOF PASSINGXII R.B.S 2 5 MAY 2011X R.B.S 2 5 MAY 2009 90NAME OF BOARDCODEAndhra Pradesh Board of Intermediate Education 11Assam Higher Secondary Education Council 12Bihar Intermediate Education Council 13Central Board of Secondary Education 14Chhattisgarh Madhyamik Shiksha Mandal 15Council for the Indian School Certificate Examinations 16Goa Board of Secondary and Higher Secondary Education 17Gujarat Secondary and Higher Secondary Education 18Himachal Pradesh Board of School Education 19Haryana Board of Education 20J&K State Board of School Education 21Jharkhand Academy Council 22Karnataka Board of Pre-university Education 23Kerala Board of Public Examinations 24Madhya Pradesh Board of Secondary Education 25Maharashtra State Board of Secondary and Higher Secondary Education 26Manipur Council of Higher Secondary Education 27Meghalaya Board of Secondary Education 28Mizoram Board of School Education 29Nagaland Board of School Education 30Orissa Council of Higher Secondary Education 3116

Punjab School Education Board 32Rajasthan Board of Secondary Education 33Tamil Nadu Board of Higher Secondary Education 34Tripura Board of Secondary Education 35U.P Board of Higher School & Intermediate Education 36Uttaranchal Shiksha Evam Pariksha Prishad 37West Bengal Council of Higher Secondary Education 38Others 3923. DETAILS OF QUALIFYING EXAMINATION FOR PG: Write the name of qualifying examination, College, University, month and yearof passing and percentage marks obtained. In case the Result has not been published, the marks obtained should be produced at thetime of Counseling. For example, an MBA, Applicant should give BBA, details.EXAMINATION COLLEGE UNIVERSITY MONTH/YEAR OF AGGREGATE %PASSINGMARKBBA SCHOOL OF ITM MAY 2010 71%BusinessUNIVERSITY24. PROGRAMME APPLIED: For the Course code, refer to the list given in pages 6 and 7 of Brochure. An applicant can give fivechoices based on his / her preference. For example, if an applicant is applying for B.Tech with Branch/Specialization “Choice 1 asAutomobile Engineering, Choice 2 as Computer Science Engineering, Choice 3 as Mechanical Engg., Choice 4 as Civil Engg. andChoice 5 as NIL”, it should be written as:0 8 0 3 0 2 0 1choice 1 choice 2 choice 3 choice 4 choice 525. TEST CITY: Refer to the following table for test centre codes. Leave the box unfilled, if not applicable. For example, if anapplicant prefers GWALIOR as test city, if should be written as:1 0 2CODES OF THE TEST CITY CENTERS (Reference for Item No. 25)STATE CENTRE CODE STATE CENTRE CODE STATE CENTRE NAME CODENAMENAMEMadhya Bhopal 101 Uttar Allahabad 129 West Bengal Durgapur 157Pradesh Gwalior 102 Pradesh Bareilly 130 Kolkata 158Indore 103 Faizabad 131 Siliguri 159Sheopur 104 Ghaziabad 132 Himachal Pradesh Dharamsala 160Jaura 105 Gorakhpur 133 Shimla 161Sabalgarh 106 Jhansi 134 Jammu & Kashmir Srinagar 162Morena 107 Kanpur 135 Assam Dibrugarh 163Ambah 108 Lucknow 136 Guwahati 164Bhind 109 Meerut 137 Chhattisgarh Bilaspur 165Lahar 110 Noida 138 Raipur 166Bhander 111 Varanasi 139 Rajasthan Kota 167Datia 112 Lalitpur 140 Dholpur 168Dabra 113 Bihar Bettiah 141 Bharatpur 169Shivpuri 114 Bhagalpur 142 Jaipur 170Kolaras 115 Buxar 143 Maharashtra Mumbai 171Guna 116 Darbhanga 144 Pune 172Tikamgarh 117 Gaya 145 Karnataka Bengaluru 17317

Madhya Chhatarpur 118 Bihar Muzaffarpur 146 Gujarat Vadodara 174Pradesh Panna 119 Nalanda 147 Nepal Kathmandu 175Satna 120 Patna 148 Bhutan Thimphu 176Damoh 121 Samastipur 149Bhind 122 Jharkhand Bokaro Steel City 150Bina 123 Dhanbad 151Uttar Chitrakut 124 Jamshedpur 152Pradesh Orai 125 Ranchi 153Auraiyya 126 New New Delhi Janakpuri 154Etawah 127 Delhi New Delhi Karol Bagh 155Banda 128 New Delhi Pitam Pura 15626. Preferred date/s of ITM-NEST 2012: You can opt any two of the following test dates:DATES CODE DATES CODEMonday, April 16, 2012 A Monday, May 21, 2012 ETuesday, April 17, 2012 B Tuesday, May 22, 2012 FWednesday, April 18, 2012 C Wednesday, May 23, 2012 GThursday, April 19, 2012 D Thursday, May 24, 2012 HFor example ,if you select (i) APRIL 16,2012 (code- A) and (ii) May 23,2012 (code-G) as your preferred dates then the preference willbe filled as below:AGchoice 1 choice 2First merit list for admission will be declared in the first week of May, 2012. Candidates writing ITM-NEST2012 in the month of May, 2012 will be considered for admission only for non reported seats.27. If you have a valid score of Gate & appearing for MAT, indicate as below.(A) HAVE VALID SCORE(B) APPEARING FORGATE MPPET CAT CMAT MAT XAT IIT-JEE AIEEE MPMET01 02descriptioncodevalid score 01appearing FOR 0228. WORK EXPERIENCEIn Months (as on 01/01/2012)In Sectors29. PAYMENT OF APPLICATION FEE: A. Along with form printed in ITM-NEST BROCHURES – Rs. 350/- amount of Demand Draft(DD) B. Along with downloaded/Photocopied Form Rs. 500/*- amount of Demand Draft (DD). Fill up the DD Number, Amount, Date,Issuing Bank & Branch name. Also, write your name, mobile number on the reverse of the DD.30. DECLARATION: Applicants and the Parent/Guardian must sign (with date) the declaration to authenticate the information providedby them. Unsigned application will not be accepted.LAST DATE OF ACCEPTANCE: 31st March, 2012director, ADMISSIONS & COUNSELLING, ITM UNIVERSITY, GWALIORAdmission Helpline : 0751-3921000*ITM-NEST - 2012 (ITM National Entrance & Scholarship Test) to be conducted by Tata Consultancy Services Ltd. on All India basis.Contact: Ph. 0751-2440057, 2440059, 2440065 Mobile : 09425308942, 09425308939, 08989103318*Rs. 150/- Application Form Fee + Rs. 350/- ITM-NEST 2012 Fee18

application formITM-NEST 2012Roll No.(For office use only)application form no(to be alloted by the University)Fill details in English using CAPITAL lettersRead carefully the instructions to fill detailsUse black or blue Hi-Tech point for filling details2. name of the applicant1. PHOTOGRAPHPaste your passportsize color photographDo not pin or staple3. date of BIRTH 4. gender 5. blood groupSignature of Applicantdatemonthyear male female6. RELIGION 7. nationality8. CATEGORY 9. mother tongue(obc, sc, st, ur or bpl)10. name of the parent / guardian11. address for correspondence (do not repeat name)12. city 13. state 14. pin code15. std code 16. telephone number 17. mobile number18. e-mail address19. parent’s annual income (`)Below 60,000 60,000 to 2,40,000 2,40,000 to 5,00,000 Above 5,00,00020. parent’s OCCUPATION

21. hostel requiredA. YES NO B. Hostel room preference C. food preference D. comfort preferenceA B A B A B22. details - xth and xiith standardsschool EXAM SCHOOL BOARD MONTH / year of % of marksPASSINGXIIX23. details of qualifying examination for ug / pg programsexamination college university month / year of % of marksPASSING24. program applied forchoice 1 choice 2 choice 3 choice 4 choice 525. test city PREFERENCE 126. preferred dates for ITM-NEST23choice 1 choice 227. (A) Have valid score (B) appearing forGATE MPPET CAT CMAT MAT XAT IIT-JEE AIEEE MPMET28. work experienceIn months (as on 01/01/2012)In Sector29. payment of application fee of `. 350.00 / `. 500.00* to be drawn in favour of ‘itm university,gwalior’ payable at gwalior.payment mode number amount ` date issuing bank branchNAMEdemand draft30. declaration:I hereby declare that I have carefully read the instructions and particulars supplied to me and that the entries made in this application form are correctto the best of my knowledge and belief. I note that the decision of the university is final in regard to selection for admission. If selected for admission,I promise to abide by the rules and regulations of the university and the guidelines in the prospectus. The university shall have the right to expelme from the university at any time after admission, provided it is satisfied that I was admitted on false particulars furnished by me or my antecedentsprove that my continuance in the university is not desirable. I agree that all disputes are subject to the jurisdiction of the courts at GWALIOR at only.Fees paid on counseling and admission will not be claimed back under any circumstances. I Certify that I (a) satisfy the eligibility requirements ofthe programme(s) I have applied for and (b) have furnished complete and correct information also certify that photograph uploaded / pasted on thisform is the latest and I also agree to abide by ITM University Gwalior decisions on all matters regarding this application. In case of any discrepancyITM University Gwalior has full right to cancel my candidature.……………………………………….............. ……………………………………….. …………………………SIGNATURE OF PARENT/legal GUARDIAN SIGNATURE OF APPLICANT DATE*Rs. 150/- Application Form Fee + Rs. 350/- ITM-NEST 2012 Fee