Download Report

Application Form
Direct Admission of Foreign and NRI Students (DAFS)
B Tech 2015
Instructions:
(i) Before filling the Application Form, please read instructions carefully.
(ii) Use black ink/ball pen and CAPITAL LETTERS for filling this Form.
(iii) Tick () in appropriate box, wherever given.
APPLICATION NO.
(For Office Use Only)
1. Program preference: Mark First as ‘1’, Second as ‘2’.
B Tech in Information and Communication Technology (ICT)
B Tech (Hons) in ICT with Minor in Computational Science
2. Name (in Capital Letters)
3. Sex (Tick )
Male
5.
4. Date of Birth
Female
Date
Month
Year
Paste
(do not staple)
your photograph
here
6. Address for Correspondence
(in capital letters with black pen)
Address Line 1
Address Line 2
Address Line 3
City / Town
State/Province
Country
Pin/Zip Code
7. (a) Phone No. (with International Code and area code)
(b) Fax No. (with International Code and area code)
(c) E-mail
8. (a) Name of Father / Guardian (as per 10th/12th Examination Certificate)
8. (b) Name of Mother
9. Relationship – in case of
Guardian
10(a). Board/University of the Qualifying Examination (with Address)
10(b). Name and address of the School/Institution of the Qualifying Examination
11. Year of Qualifying Examination
12. Percentage / GPA
10th
12th
Attach authenticated transcripts of grades/marks secured in the qualifying exam and all the Terms/Semesters leading to the
qualifying examination.
13. Number of years you had education abroad inclusive of 10+2 (not beyond) (Applicable to NRIs Only)
14. a) Score in JEE Mains/ SAT / AP / UK Equivalent exams
Physics (P)
Chemistry (C)
Mathematics II-C (M)
Total (P+C+M)
b) Number of appearances in SAT / AP / UK Equivalent exams
15. Nationality
16. Particulars of the Passport
Number:
Place of Issue:
Date of Issue:
Country of Issue:
Valid Up to:
17. Issuing Authority of Proof of NRI Status
18. Application Fee
Demand Draft No. /
Wire Transfer Reference
No.
Date
Amount in
Rs. (`) / USD ($)
Issuing Bank (with address)
19. Declaration by the candidate
I hereby declare that all the particulars stated in this application are true to the best of my knowledge and belief. I
have read the Admission Procedure for DAFS and I shall abide by the terms and conditions therein. In the event of
suppression or distortion of any fact like Qualification, Nationality etc, made in Application Form, I understand that
my application for admission under DAFS is liable to be rejected and if already admitted, my admission is liable for
cancellation. I also understand that the decision of the authorities of Dhirubhai Ambani Institute of Information and
Communication Technology (DA-IICT), Gandhinagar, Gujarat, India regarding my admission will be final and I shall
abide by their decision. Further, if admitted, I promise to abide by the rules and regulations of the institute and
applicable Government Rules.
Place:
Signature of the Candidate:
Date:
Countersigned by: Parent/Guardian:
Eligibility for applying under Direct Admission of Foreign and NRI Students (DAFS) category For the purpose of admission to B. Tech programs, the following categories of applicants will be considered as Non
Resident Indians:






Overseas Citizen of India (OCI) card holders.
Persons of Indian Origin (PIO) card holders.
Certificates of Non Resident Indian issued by the Indian Embassy/Indian Consulate of the Country where the
Non Resident Indian is residing.
Passport of an applicant indicating his status as 'Non Resident Indian'.
Persons who have studied outside India and have passed either 10th or 12th standard (or must be appearing
for in 2015) or equivalent from any system of education subject to the eligibility criteria stipulated below.
Either of the parent of the applicant residing abroad and submits documentary proof that she/he is a Non
Resident Indian (e.g.,NRI bank account in India). The NRI status should be valid until 1st August, 2015.
Instructions for Completing the Application Form
Write with black ink/ball pen using CAPITAL LETTERS of English only.
1. Program preference: Mark First as ‘1’, Second as ‘2’.
2.
Name: Write your name in capital letters as given in your original certificate of the High School or your first
Board/University Examination. Write a single letter in a box. Leave one blank box between any two parts of the
name, as shown in the example below.
B
H
U
L
A
B
H
A
I
H
I
R
A
B
H
A
I
D
E
S
A
I
3. Sex: Tick the appropriate box.
4. Date of Birth: Enter the date, month and year of your birth as recorded in your Board examination certificate.
Use numerals only.
0 4
1
1
2
9
9
4
5. Photograph of the Candidate: Paste (do not staple) a recent (not more than two month old), good passport
size photograph.
6. Address: Write the complete postal address, to which any communication is to be sent, in English. Please
fill the fields as shown below. The field(s) not applicable to you may be kept blank. The text should not overflow
the space provided
Add Line 1
15, NOBEL APARTMENTS
Add Line 2
GILLMAN DRIVE
Add Line 3
LA JOLLA
City/Town
SAN DIEGO
State/Province
CALIFORNIA
Country
USA
PIN Code
53219
7. Phone number: Write your phone number, fax number, and e-mail address on which you can be contacted or a
message can be left for you. Use the boxes in the first group for the country code, boxes in the second group
for the area code and boxes in the third group for the telephone number. For example, the number 11-1184512001 will be entered as below.
1
1
1
1
8
4
5
1
2
0
0
1
8(a). Name of F a t h e r /Guardian: Write the name of F a ther or guardian exactly as in your Board Certificate, if
given. Otherwise write the name of your Father or guardian as in your Passport. Leave a box blank between any
two parts of the name.
8(b). Name of Mother : Write your Mo ther ’s name in capital letters as in your Passport.
9. Relationship: Tick the appropriate box. In case of the guardian, indicate your relationship.
10. (a). Board/University of Qualifying Examination: Write name and address of the Board/University.
(b). School/Institution of the Qualifying Examination: Write name and address of the school/institution of the
Qualifying Examination
11. Year of Qualifying Examination: You must write the year of passing the qualifying examination. For example, if
passed in 2014, write 2014. Those who are appearing for their qualifying examination in 2015 should write 2015.
12. Percentage of Marks: Write the actual percentage of aggregate marks and/or GPA obtained in qualifying
examination if the results are available; otherwise leave blank. The percentage should be rounded off to the nearest
integer. Attach authenticated transcripts of grades/marks secured in the qualifying exam and all the Terms/Semesters
leading to the qualifying exam.
13. Write the number of years for which you have received education abroad, inclusive of qualifying examination. Attach
documentary proof from the principal of your school or any competent authority.
14. Score in JEE (Mains) / SAT / AP / UK Equivalent exams: Write your JEE (Mains) SAT / AP / UK Equivalent exams
scores in the boxes provided.
15. Nationality: Write your nationality.
16. Particulars of the Passport: Give particulars of Passport as required.
17. Please attach a copy of the certificate/document from the appropriate authority indicating your residency status as
NRI.
18. Application Fee: Give particulars of the payment of Application Fee as required.
19. Declaration by the Candidate: You must sign the declaration. The place and date should also be mentioned. Your
application is to be countersigned by your parent/guardian.