Eform

Personal Details

Name of Applicant (As in Qualifying Examination)*

Date Of Birth*

Gender*
Male Female

Mobile No.*

Applicant Email ID*

Nationality*

State of Domicile*

Category*

Father's Name*

Mother's Name*

Parent Mobile No.*

Admission Status

Applicant Admission Status

Applicant Pulled Status

Present Address

Address Line 1*

Address Line 2

Town/City*

Country*

State*

District*

Pin Code*

Permanent Address Same as Present Address?

Yes No

Permanent Address

Address Line 1*

Address Line 2

Town/City*

Country*

State*

District*

Pin Code*

Document Upload (Optional)


Upload your Photograph here.
Upload your Signature here.

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Course Choices

Courses

Type*
Please select course category option

Diploma Under Graduate Post Graduate Ph.D.

*Certificate

Certificate course in Spanish

Certificate course in French

Certificate course in German

Certificate course in Italian

Certificate course in Japanese

Certificate course in Mandarin language

Diploma

Diploma in Engineering

Diploma in Engineering (Lateral)

Ph.D.

Full Time

Part Time

Under Graduate Courses

B.Tech

B.Tech+MBA (Integrated)

B.Tech-M.Tech (Integrated)

B.Tech(Lateral Entry)

B.Pharma

B.Pharma(Lateral Entry)

D.Pharma(Diploma in Pharmacy)

BCA

B.Sc Information Technology (IT)

BBA in association with IBM

BBA-MBA (Integrated)

B.Sc (General)

B.Sc(Hons.)

B.Sc(Hons.) in Nutrition & Dietetics

B.Sc(Hons.) Agriculture

B.Com(General)

B.Com(Hons.)

B.A (Hons.)

Bachelor of FineArts(BFA)

Bachelor of Design(B.Des)

B.A - LL.B

LL.B

BDS

B.SC Nursing

Bachelor of Physiotherapy (BPT)

B.Sc Optometry

B.Ed

Post Graduate Courses

M.Tech

MBA

M.A

M.Pharma

MCA

M.Sc

MDS

M.Com

*Nursing Courses

GNM

B.SC Nursing

Select Discipline

Discipline

Accomodation & Transport Requirement Details

Note: Subject to availability

Do you need hostel accommodation?*
Yes No

Do you need transport?*
Yes No

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Please recheck your data before confirming.
Once you proceed, you will not be able to make changes in your data and this data cannot be reverted back.

Qualifying Examination Details

Name of the Exam	Name of Board / University	School / College / Institute Name	Status of Result	Year of Passing	Marks / CGP Obtained	Maximum Marks	Percentage of Marks
10th
12th
Diploma
UG
PG

Are the result and details of the qualifying exam available now?* Yes No

Qualifying Examination*

Roll Number*

Specify Others*

Note: Please enter 0(ZERO) in case you have not appeared for any Subject listed below.

Subject/Discipline Offered	Marks obtained	Maximum marks	Percentage
1. English
2. Physics
3. Chemistry
4. Maths
5. Biology/Biotechnology
6. Comp. Sc.
7. Biotechnology
8.
9.
10.
11.
12.

Total Marks / CGPA Obtained*

Total Percentage*

Board/University*

Year Of Passing (YYYY)*

Note: Please note that all relevant information and details if applicable to you should be sent to PDM as and when they are available, but before the last date of application.

Have you Appeared/Appearing in JEE-2022?*
Yes No

Are the result and details of the JEE-2022 available now?* Yes No

What is your All India Rank(Overall) and Roll Number of JEE-2022?*

What is your Roll Number of JEE-2022?*

All India Rank(Overall)*

Roll Number*

Marks Obtained*

Are the result and details of the NEET-2022 available now?* Yes No

What is your All India Rank(Overall), Roll Number & Marks of NEET-2022?*

What is your Roll Number of NEET-2022?*

All India Rank(Overall)*

Roll Number*

Marks Obtained*

Have you Appeared/Appearing in DET-2020?* Yes No

Are the result and details of the DET-2020 available now?* Yes No

What is your All India Rank(Overall) and Roll Number of DET-2020?*

What is your Roll Number of DET-2020?*

All India Rank(Overall)*

Roll Number*

Have you Appeared/Appearing in GPAT?*
Yes No

What is your GPAT Score?*

GPAT Score*

Year*

Roll No*

Whether you have qualified M.Phil?*
Yes No

Specify the title of Dissertation*

Research Discipline / Area*

Month & Year of successful completion of M.Phil*

Name of the University & Place*

Whether you have qualified candidate of National / State Level Test namely (NET/NET-JRF/GATE/SLET) OR ANY OTHER TEST?*
Yes No

Type of Test Qualified*

Roll No*

Score*

Rank*

Qualifying Year*

What is your NATA/JEE Main Paper-2 Score?

NATA/JEE Main Paper-2 Score*

Year*

Roll Number*

Have you Appeared/Appearing in NEET-MDS 2022?* Yes No

Are the result and details of the NEET-MDS 2022 available now?*
Yes No

What is your All India Rank(Overall) and Roll Number of NEET-MDS 2022?*

What is your Roll Number of NEET-MDS 2022?*

All India Rank(Overall)*

Roll Number*

Marks Obtained*

Have you Appeared/Appearing in Diploma ( Lateral Entry )-2016?* Yes No

Are the result and details of the Diploma ( Lateral Entry )-2016 available now?* Yes No

What is your All India Rank(Overall) and Roll Number of Diploma ( Lateral Entry )-2016?*

What is your Roll Number of Diploma ( Lateral Entry )-2016?*

All India Rank(Overall)*

Roll Number*

Have you Appeared/Appearing in CMAT ?*
Yes No

Roll No*

Percentile*

Year of Passing*

Have you Appeared/Appearing in OLET-LEET-2022?* Yes No

Are the result and details of the OLET-LEET-2022 available now?*
Yes No

What is your All India Rank(Overall) and Roll Number of OLET-LEET-2022?*

What is your Roll Number of OLET-LEET-2022?*

All India Rank(Overall)*

Roll Number*

Marks Obtained*

Have you Appeared/Appearing in GATE ?*
Yes No

What is your GATE Score?*

Gate Score*

Year*

Discipline*

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Payment Procedure

Note: Applicants are required to remit Rs 2000 as application fee. The amount can be remitted to us by following three modes.

Note: Applicants are required to remit Rs 1000 as application fee. The amount can be remitted to us by following three modes.

Note: Applicants are required to remit Rs 500 as application fee. The amount can be remitted to us by following three modes.

Cash payment at PDM

Note: The candidate has to pay the fee at the PDM, he/she will be provided with a scratch card and broucher.

Cash Payment through Scratch Card

Payment at PDM

Note: Please enter the Scratch Card Number.

Scratch Card Number*

Online Payment (Credit Card / Debit Card / Netbanking / Paytm wallet)

Note: After clicking submit button below, you will be redirected to our secure payment gateway to complete the payment.

Card Holder's Name*

Amount*

Payment Status*

Application enclosures

Note: Please enclose the following documents in original alongwith this form printout at the time of physical counselling.

1. Rank Card of the relevant Entrance Test(s) as claimed in the application form.
2. Matriculation / High School Certificate (for Date of Birth)
3. Qualifying Examination i.e. 10+2 / Diploma / Graduation / Post Graduation or any other examination (for eligibility)
4. Character Certificate from the Institution last attended (for regular students)
5. Migration Certificate
6. Address Proof (Ration Card / Electricity Bill / Telephone Bill, etc.)
7. SC/BC Certificate ( if Applicable)
8. 6 Passport size recent colored photos
9. Certificate of Medical Fitness in the prescribed Performa.
10. Affidavits in Prescribed format regarding non indulgence in ragging.

Declaration

I declare the information provided by me is true in all respect and in case any information found to be false, my admission would stand cancelled automatically.
I am aware that taking part in Ragging is a criminal offence and a person indulge in any such activity is liable to be prosecuted under law of the land. I understand not to participate in any act of RAGGING and in case of violation of any of the rules, I will be liable to strict disciplinary action, which will even lead to my expulsion from the College.
I will abide by the Ordinance / Regulations / Rules of the College, which are in force at the time of my admission or which may be subsequently made applicable during my course of study.
I will maintain at least 75% attendance in each semester as per the rules and regulations of the University, failing which I may be debarred from appearing in the term and examination and punished as per rules / regulations etc.
In case, I am found involved in any act of misconduct or moral turpitude in and / or outside the College premises or any act of damage to the College property / equipment, for which a complaint is lodged with the College authorities or with the police authorities, I will be liable to any disciplinary action as decided by the College Authorities. I will pay the fees as applicable from time to time, regularly by the stipulated date.

......................................
Signature of the Candidate

UNDERTAKING OF PARENT / GUARDIAN
I, _______________________ Father / Mother / Guardian of Mr. / Ms. _________________________ who has sought admission in the College in 1st year, do hereby undertake that shall ascertain at my own level from the College Authorities during the academic session about the attendance of my son / daughter / ward and whether he / she is meeting the attendance requirement as per current provisions in the relevant ordinance of the affiliating University.
I have read the declaration made by my son / daughter / ward as above and endorse the same. I understand to keep myself abreast of the progress of my son / daughter / ward including his / her attendance in the class.
I certified that the information has been verified from the Original documents and eligibility of the candidate has been ascertained as per provisions of the affiliating University / State Govt.

......................................
Countersigned by Parent / Guardian

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