Delhi Technological UniversiTy, Delhi

(Formerly Delhi college of engineering) application Form for admission to the B.Tech. Programs 2011-2012
( For Foreign national {Fn}, Persons of indian origin [Pio] and nris) last date for receipt of applications is 30th June, 2011 (Thursday). Submit the completed form to the Joint Registrar (Admin.), Delhi Technological University, Shahbad Daulatpur, Bawana Road, Delhi-110042. Note : (a) Fill up the Form completely. Your application is liable to be rejected, if any of the item is unfilled or incomplete. (b) Use Capital letters only.

(For Office Use) Application No.

1.

(a) Applicant's Name (b) Application Fee : Demand Draft No. Issuing Bank Date Amount

Affix your recent passport size photograph duly attested by the Principal of the School Last attended

2. 3.

Category (Please tick in appropriate box) 2.(a) FN 2.(b) PIO SAT-II Examination Details (SAT Scores) (a) Roll No./Registration No. (b) Score Maths-II

2.(c) NRI (c) Score Physics (d) SAT Total Score

4.

Sex (Write M for Male, F for Female)

5.(a) Nationality 6.(b)

5.(b) Religion

6.(a) Date of Birth 7.

Shortage in age, if any Day Month Year (if not 17 years on 01-09-2011, then indicate shortage) Indicate the branch codes in order of your preferences (See para 3.10 of prospectus) Branch Codes I II III IV V VI VII VIII IX X XI XII XIII XIV Order of Preferences (Note : The options indicated here CANNOT be changed later on. The applicants are required to fill all the preferences, otherwise the application form will be treated incomplete and is liable to be rejected)

M M D D

8.

Particulars of the Qualifying Examination passed (XII or equivalent, refer to prospectus, Section 3.2) 8.(a) Examination Passed 8.(b) Board/University 8.(c) Name of the College/School and address with ZIP Code Country 8.(d) Year of Passing 8.(e) Marks Obtained English Physics Chemistry Mathematics Others Aggregate of results Roll No. Marks Secured Max. Marks ZIP Code 8.(f) PCM % 8.(g) Aggregate PCME % I certify that I belong to category as in Para 2 above Signature of the Applicant

9.

Applicant's Postal Address

Email 10. Permanent Address

Mobile

ZIP Code

ZIP Code 11. (a) Father's / Guardian's Name Occupation

Country

Residential Address

Official Address

ZIP Code Tel. (R) Mob (b) Mother's Name

ZIP Code Tel. (O) E-mail

12.

Annual Income of Father / Guardian

13.

Local Guardian's Name (in Delhi)

Relationship with the applicant

Residential Address

Official Address

PIN Tel. (R) Mob Tel. (O) E-mail

PIN

14.

Have you passed 'English' as a subject at X or XII class Level? If yes, indicate the higher class.

15.

Certificate by the Principal of the school last attended / Education Secretary (Embassy) Certified that I have attested the photograph of the applicant Mr./Ms. ........................................................................... pasted on first page by signing across the same. I further certify that the information given at items no 6(a), 8, 14 & 15 is correct as per our record. The conduct of the applicant has been satisfactory and he/she bears a good moral character.

Signature of the Principal of School/College where the Applicant studied last or Seal of the School/College To be certified by Embassy of India in that country

Name and address of the School / College last attended (with ZIP Code)

Country & City

ZIP Code

16.

List of Enclosures (tick R in appropriate boxes) (Photocopies only) 1. Copy of Passport 2. Copy of SAT-II, Score Card for Maths-II & Physics 3. Class X (Date of Birth Certificate) 4. Class XII / Equivalent Exam Marks Sheet 5. Proof of 5 years stay abroad for NRI Candidates 6. Transcription / Grade Sheet of the qualifying examination should be attested by School / Institution 7. Affidavit on Non-Judicial Stamp Paper for Persons of Indian Origin of his/her parents/grand parents as per section 2(B) of Citizenship Act 1955 8. Certificate from Indian Council for Cultural Relation or Govt. of India for FN/PIO Category

18.

Undertakings by the Candidates (a) I hereby certify that the foregoing particulars are correct and I agree that admission may be granted to me on the terms, conditions and rules of the DTU or such modifications thereof as may be made by authorities concerned from time to time. I understand that my admission may be cancelled and tuition fee paid by me forfeited if any of the particulars given by me in this application are subsequently found to be wrong. (b) I agree that Vice-Chancellor's decision in all matters concerning my admission, studies, discipline and conduct will be final and binding on me. (c) I have not left any Engineering Degree course or an equivalent course after exhausting the permissible number of chances in any other University / Board. (d) I understand that my association, active or passive, with any unlawful organization is forbidden. (e) I am not registered/enrolled for any other course of any other University or I am registered for ......................... ................................ course of .................................................. University / Institution and undertake that I shall withdraw my admission if admitted in DTU. (f) I agree that the DTU shall have the right to forfeit the security deposits inter alia on the ground of my failure to claim the refund within one year of the date of my ceasing to be on the rolls of the DTU. (g) I undertake to abide by the law of the land during my stay in India.

Date: .........../............/2011 19.

Signature of the Applicant

Undertakings by Parents / Guardian (a) I testify that my son / daughter / ward ....................................................................... is seeking admission with my consent and I am personally responsible to the University for payment of all his/her dues as the Vice-Chancellor may decide. I assure that the applicant will abide by the rules of the University as laid down by the Vice-Chancellor, Delhi Technological University (DTU). (b) I have read the rules and I understand that my son/daughter/ward has to undergo obligatory practical training for specified periods in accordance with the relevant Ordinance of the DTU. I agree that in the event of my ward being placed in an industrial installation outside Delhi for such practical training. I will not raise any objection for his/ her being so placed. (c) I hereby certify that the foregoing particulars furnished in this application form are correct.

Date: .........../............/2011 Place : ............................... Name Address

Signature of the Parent / Guardian

Pin/ZIP Tel (O)

Tel. (R) Mob.