Application No.

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MODY INSTITUTE OF TECHNOLOGY & SCIENCE

(Deemed University under section 3 of U.G.C. Act ,1956)
LAKSHMANGARH, Dist. SIKAR – 332311 (RAJASTHAN)
Phone: 01573-225001-12 (12 Lines) Fax: 01573-225041
E-Mail: dean.fet@mitsuniversity.ac.in; dean.fms@mitsuniversity.ac.in
Website: www.mitsuniversity.ac.in
Please Fix
ADMISSION FORM (Advanced Standing) a Passport
Size
Session : 2008-2009
Photograph
Semester : Autumn Spring

Programme Applied:

B.Tech CS&E B.Tech E&CE B.Tech IT M.C.A. M.B.A.

1. Name of the Candidate (Last Name First)

2. Father’s Name (Last Name First)

3. Mother’s Name (Last Name First)

4. Address

City PIN

5. Phone No. with STD Code: __________________ 6. Email, if any ___________________

7. Date of Birth: Day Month Year

8. Nationality: Indian NRI Foreigner, Country ________________

9. If Foreigner/NRI, Passport No. ______________ 10. Religion: _____________________

11. Guardian’s Name & Occupation ______________________________________________

12. Guardian’s Annual Income ____________ 13. Are you a single girl child?

14. Which Category you belong to: SC ST OBC GENERAL

15. Accommodation : Hostel Seat Required Own Arrangement

16. Application Fee Details (in case of downloaded form):
DD No. ___________ Bank ___________________ Amount _______ Date __________
PROGRAMME APPLIED

UNDERGRADUATE PROGRAMMES (Give preferences like 1,2 and 3)

1. B.Tech. in Electronics & Communication Engineering
2. B.Tech. in Computer Science & Engineering
3. B.Tech. in Information Technology

Eligibility: Pass with a minimum of 60 % aggregate in 10+2 from CBSE or its equivalent from
other Boards with Physics, Mathematics, Chemistry/Computer and adequate
proficiency and successful completion of at least one semester in the respective
degree programme or a Diploma with a minimum 50% aggregate or equivalent
CGPA from any recognized Board / University.

POSTGRADUATE PROGRAMMES (Please √ Tick)

1. Master of Business Administration (M.B.A.)
2. Master of Computer Applications (M.C.A.)

Eligibility: Graduation in any discipline with at least 50% marks in qualifying examination and
successful completion of at least one semester in the respective degree programme.
ACADEMIC RECORD
Last Programme of Study _____________________________________________________
Last Programme Completed: Totally Partially till _________ Semester(s) / Years(s)
Institute Last Attended: _______________________________________________________
University / Board ___________________________________________________________

Exam Passed Year Board/University Division Percentage

X
XII
Details of Education beyond XII

For Applicants of B.Tech. Programmes only

Details of Admission Test(s) through which you got selected to the B.E. / B.Tech Programme
which you had completed partially.

Testing Agency Merit / Score

Date Signature of the Candidate

 DECLARATION

I, ______________________________ declare that all the information given in this

application form is true to the best of my knowledge. I assure that I shall abide by all the
rules and regulations of the Institute which are in vogue as well as those which come in to
force later. I further assure that I would do nothing inside or outside the Institute that would
go against the discipline and orderly working of the Institute. I understand that if (1) any
information herein is found to be incorrect, or (2) I am found indulging in any act of
indiscipline, or (3) I fail to pay the dues in time, I shall be liable to the punishment as
awarded by the Institute which may even include striking off my name from the rolls of the
Institute.

Date Signature of the Candidate

CERTIFICATE FROM THE FATHER / GUARDIAN

I, ______________________________ father / _________________________ of

Ms. ______________________, who is a candidate for admission in the Institute, certify that
I am the bonafied guardian of the candidate. I assure that the candidate and I shall abide by
the all the rules and regulations of the Institute which are in vogue as well as those which
come in to force later. I further assure that all the required fees would be paid in time.

Date Signature of the Guardian

(For Office Use Only)

Admission Offered: YES NO

Programme Offered :
B.Tech. E&CE B.Tech. CS&E B.Tech. IT MCA MBA

List of Courses exempted is attached. (Copy sent to Registrar)

___________________
Signature of the Dean
ENCLOSURES:
(Please ( √ ) tick the items enclosed with this application)
1. Copy of Certificate of X standard

2. Copy of Marks Sheet of XII standard

3. Copy of Marks Sheets of all Examinations passed beyond XII

4. Copy of Certificate of SC/ST/OBC, if any

5. Copy of Merit/Score Sheet of Admission Test

Write the Examinations whose Mark sheets as per item (3) above are attached

_____________________________________________________________________

_________________________________________________________________________

_____________________________________________________________________

The Copies of the above ( √ ) ticked items are enclosed.

Date Signature of the Candidate