Effective Date: 31.12.2002 Version Number: 1.

0 Evaluation form for US Admission Counseling Name (as in the PassPort) Date of Birth 4/44 FAM CHS , plot No-19 sector 11 koparkhairane. Navi-mumbai Present Address

Gurukul(India).Com Ltd

SHAH KASHYAP ROHITKUMAR

9/13/1985

Phone Permanent Address

105 Nirman Sanket Appt, Opp Post office, Main -road . Roha -Raidag. Maharashtra. PIN-402109

Phone E-Mail kashyapshah139@gmail.com

902862968

Educational Qualifications: (Starting from the highest Qualification to Xth Std.)

Degree/ Diploma / Certificate Post Graduation 4th Yr. Degree Swami Ramanand Teerth Marathwada University, Nanded Swami Ramanand Teerth Marathwada University, Nanded Swami Ramanand Teerth Marathwada University, Nanded Shri Guru English Gobind Singhji Institute of Engineering & Techniligy, Nanded Shri Guru English Gobind Singhji Institute of Engineering & Techniligy, Nanded Shri Guru English Gobind Singhji Institute of Engineering & Techniligy, Nanded 2010 Electronics & Telecommunica tion 6.98 University / Board Name of the College Medium of Instruction Year of passing Course/ Subject details % Marks obtained by you/ CGPA %Marks obtained by Topper/ CGPA

3th Yr. Degree

2009 Electronics & Telecommunica tion

6.74

2th Yr. Degree

2008 Electronics & Telecommunica tion

7.4

1th Yr. Degree 3rd year Diploma

Dr. Babasaheb Ambedkar Technological University, Lonere Dr. Babasaheb Ambedkar Technological University, Lonere Dr. Babasaheb Ambedkar Technological University, Lonere Maharashtra State Board

Institute of Petrochemical Engineering, Lonere Institute of Petrochemical Engineering, Lonere Institute of Petrochemical Engineering, Lonere

English

2007 Electronics & Telecommunica tion 2006 Electronics & Telecommunica tion 2005 Plastic & Polymer

82.37

2nd year Diploma

English

78.15

1st year Diploma

English

76.48

H.S.C

Issued By - MR

Bhartiya Vidya English Bhavans, Grgoan-

2003

49.5

Approved By - CEO

Effective Date: 31.12.2002 Version Number: 1.0 Evaluation form for US Admission Counseling Project Details
Title Mine Detector Using R/c Vehicle (Diploma): Rover (Main project, Semester I ): with Image Capturing (Main project, Semester II ): Completion Date Description Name of Guide Project detail: The project consisted of May-07 building a R/c vehicle Mr. D.G.Jadhav Project detail: The project consist of Nov-09 building a microMr.Sunil.Jatti Project detail: The project consist of Apr-10 building a robot Dr. A.V.Nandedar

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Do you have the ORIGINAL transcripts for courses after HSC: no not yet Details of Work/Business Experience:
Name of Organisation Fr. Conceicao Rodrigues institute of Technology Joining Date (Month & Year) Aug-10 Release Date (Month & Year) Designation lecturer Job Profile teacher

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Approved By - CEO

Effective Date: 31.12.2002 Version Number: 1.0 Evaluation form for US Admission Counseling Details of the Family Members (Father / Mother and Brothers / Sisters):
Name Alka Rohitkumar Shah Karishma Srujal Jariwala Relationship with you Mother sister Age (Years) 57 23 Educational Name of the Qualification Employer Bsc(home Konkan Education Science), B.Ed Soceity Bcs(fashion PNC, USA designing) Work Exp. (years) 24

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IT Returns nil

Annual Income 192,000

0.5

Test Score:
Test Date Score Break up Remarks

Details of Extra Curriculum Activities:

Oraganisation Institute of Petrochemical Engineering NCC Event / Activity At Age of Description 19 National Cadet Corps is a TriServices Organisation comprising the Army, Navy and Air Force, engaged in grooming the youth and I was Corporal yes Institute of Petrochemical Engineering NCC- Disaster Management Camp 22 As NCC being the one of biggest skilled work force keeping this intomind this camp was organized to trained the NCC cadet and help government body during disaster and natural calamity. Do you have a Certificate

yes

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Effective Date: 31.12.2002 Version Number: 1.0 Evaluation form for US Admission Counseling Do you have any preferences as location / cost etc.?

Gurukul(India).Com Ltd

columbus- ohio.

Have you thought of any particular University? YES / NO (If YES please give details)

yes- ohio state university- columbus

Any other details you wish to bring to our attention:

my brother-in-law is PR of USA and my sister is green card holder.

Date

7/Dec/10

Signature

To be filled in by the FACT Counseling Committee only

Remarks

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Approved By - CEO

Effective Date: 31.12.2002 Version Number: 1.0

H.S.C S.S.C Diploma Others Maharashtra State Board Maharashtra State Board Bhartiya Vidya English 2003 Evaluation form for US Admission Counseling Bhavans, GrgoanK.E.S English English 2001 49.5 57.20%

Gurukul(India).Com Ltd

Medium School

Issued By - MR

Approved By - CEO

Effective Date: 31.12.2002 Version Number: 1.0 Evaluation form for US Admission Counseling

Gurukul(India).Com Ltd

How much amount of money can you show in your bank statement/solvency certificate? Rs. Who are likely to be your recommenders?
Name Dr. Milind. Shah Mr. Sunil. Jatti Lt. Milind. Bhagat Relationship colleague teacher teacher Designation Head of Department lecturer Qualification Phd M.Tech Since when he / she knows you 3 years 2 years 7 years

lecturer/ Head of B.tech Finance department/

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Approved By - CEO

Effective Date: 31.12.2002 Version Number: 1.0 Evaluation form for US Admission Counseling What is your intended major field of study? Semester Sought

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Micro-processors/ micro-controllers/ mobile communication/ avionics

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Approved By - CEO

Effective Date: 31.12.2002 Version Number: 1.0 Evaluation form for US Admission Counseling Recomendations

Gurukul(India).Com Ltd

Issued By - MR

Approved By - CEO