1. No category

Sl.No:
M.A.M. COLLEGE OF ENGINEERING & TECHNOLOGY
M.A.M. Nagar, Trichy – Chennai Trunk Road, Siruganur,
Tiruchirappalli – 621 105. Ph : 0431-2650521, 2650516
E-Mail: [email protected]
APPLICATION FORM
For Admission to B.E/B.Tech, Degree Course 20
– 20
ADMITTED UNDER
Admission Category / Quota
GOVT.
MGT.
NRI
Space for
Passport size
Photograph
SPORTS
ADMISSION NO.:
MARKS OVERALL %:
1. Degree
B.E
B.Tech
Regular
Lateral
entry
A) Choice of Branch
i) B.E., Civil Engineering
iv) B.E., Electrical & Electronics Engineering.
ii) B.E., Computer Science & Engineering
v) B.Tech., Information Technology
iii) B.E., Electronics & Communication Engineering.
vi) B.E., Mechanical Engineering
B) Name
(In Block letters with initials at the end)
__________________________________________
:
Address for Communication
a) Permanent Address:
b) Local Address (if any):
S/o / D/o
S/o / D/o
Pin Code :
Pin Code :
2. Sex:
Male
Female
1
3. i) Date of Birth & Age :
Age:
(DD / MM / YY)
ii) Place of Birth:
(Village/Town/City)
(District)
4. Citizenship
5.
a) Community
(State)
:
ST
SC
MBC/DNT
BC
b) Name of Caste : (In case of BC/MBC/SC only)
c) Whether NRI : Yes
No
Sponsor Name :
Relationship
Country
d) Whether Minority Muslim
: Yes
6. Mother Tongue
:
7. i) Name of the Parent/Guardian
:
8) i) Occupation of the Parent / Guardian with
Designation, department / Office address
:
ii) Telephone Number
:
9. Monthly income of Parent / Guardian
2
No
OC
10. Extra curricular activities (Original Certificates must be produced at the time of admission)
Yes
No
a. Sports
b. Games
c. N.C.C.
d. Social Service
e. Other extra curricular activities
11. Proficiency in Sports and Games
Represented
Nation
State
District
Not applicable
12. Details of Study:
S.
No.
Register
No.
Year of
Passing
Name of the
Course/Discipline
Name of the
School/College/
Polytechnic
1.
2.
3.
13. Medium of Instruction
:
________________________
14. Marks obtained in the qualifying examination :
(1) HSC (Academic) or Equivalent
Subject
Marks
Obtained
Max.
Marks
ii) HSC (Vocational)
% of
Marks
Subject
Maths
Maths
Vocational
Physics
Subjects
Chemistry
Total
Total
3
Marks
Obtained
Max
Marks
% of
Marks
(III) Diploma Examination (Lateral Entry Candidates)
Semester
Marks Obtained
Max. Marks
%
V
VI
Total
Total
_______________
Signature of the Applicant
UNDERTAKING
I am fully aware that my admission is subject to the approval by Directorate of Technical Education / Anna
University. Incase of non-approval by DOTE/University, neither the College nor the Trust will be held
responsible.
Countersigned:
Parent’s signature
Candidate’s Signature
DOCUMENTS TO BE PRODUCED
PLEASE NOTE:
The following documents in original along with a set of photocopies should be
produced at the time of Admission, failing which the application is liable to be
rejected.
1. Mark list(s) of the qualifying examination (+2 / Diploma in Equivalent)
2. S.S.L.C/Date of Birth Certificate
3. Transfer Certificate from the institute last studied
4. Conduct Certificate
5. Community Certificate
6. Photos 3 nos
7. Physical Fitness Certificate
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DECLARATION
1. The information furnished is true and correct to our knowledge and belief. The original certificate
will be produced at the time of admission or on demand. If any information is found incorrect or
false, no matter at what stage of the course it is, we agree to forfeit any claim for admission/seat.
2. We agree to abide by the rules and regulations now in force and those that may come into effect from
time to time by university/government/DOTE/A.I.C.T.E and other agencies.
3. We promise to abide by all the decisions of the authorities in all matters of training, examination,
tests, assignments, conduct and the disciplinary matters with no right of questioning in any court of
law.
4. We will make good the loss or damage caused to any of the properties of the institution by us.
5. We promise that we will not involve in anything that will interfere with its functioning and
discipline, either inside or outside of the institution.
6. We accept that upon admission, a fee paid to the institution is not refundable.
7. We further accept that if the student has to leave the institution in the middle of the course, we will
pay the “special fee” for the remaining duration for transfer and other certificates.
8. We promise to abide by all the rules and regulations of M.A.M College of Engineering &
Technology.
9. We further promise to abide by rules and regulations of hostel if the student is admitted in hostel
Signature of the Applicant
Signature of the Parent/Guardian
Name:
Name:
Place:
Date:
FOR OFFICE USE ONLY
Application Form
: Accepted/Rejected
Reason for rejection : ……………………………………………………………………
……………………………………………………………………………………………
Certificates verified by:
Principal
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M.A.M. COLLEGE OF ENGINEERING & TECHNOLOGY
M.A.M. Nagar, Trichy - Chennai Trunk Road, Siruganur,
Tiruchirappalli-621105, Ph : 0431-2650521,2650516
IMPORTANT PARTICULARS
Space for
passport size
photograph
(To be filled-up by the candidate)
1. Name (in BLOCK LETTERS
With initials at the end)
: _________________________________________________
2. Address for communication
a.permanent Address
: _________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
Ph.no
b.Local Address
: ____________ ___ Pin Code:
:
Ph.no
: _____________
Pin Code :
3. Date of Birth
: _________________________________________________
4. Place of Birth
:
________________________________________________
(Village/Town/City)
District
State
5. Mother Tongue
: _________________________________________________
6. Average % of Marks in Diploma Last 2 Semesters
: _________________________________________________
7. Whether NRI Quota
: Yes
8. Whether Muslim Minoritiy
: Yes
9. Name of the Parent/Guardian
: ________________________________________________
And Residential Address
No
No
________________________________________________
________________________________________________
10. Occupation of the Parent/Guardian
: ________________________________________________
11. Telephone Number (Off)
: ________________________________________________
(Resi)
: ________________________________________________
12. Monthly income of Parent/Guardian
: ________________________________________________
13. Reference : Name & Address
: ________________________________________________
________________________________________________
________________________________________________
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