UNIVERSITY OF CALCUTTA UNIVERSITY COLLEGE OF SCIENCE, TECHNOLOGY AND AGRICULTURE

For Office use Form No………

Recommended for admission Sold by ………..

Head of the Department/

Course Co-ordinator

UNIVERSITY OF CALCUTTA

UNIVERSITY COLLEGE OF SCIENCE, TECHNOLOGY AND AGRICULTURE

APPLICATION FORM FOR ADMISSION TO FIRST YEAR M.TECH./M.PHIL. COURSES

To

The Secretary

Faculty Councils for P.G. Studies in Sc., Tech.& Engg and Ag. & Vet. Sc.

Calcutta University

92, A.P.C. Road, Kolkata – 700 009

Name of the Applicant (in block letters): __________________________________________________

Applied for Admission in Course: ____________________________Session:__________________

Subject: ____________________________________________________

Bachelor’s Degree in Engg./Tech. or M.Sc. with Subject: _____________________________________

College and University: _______________________________________________________________

Year of Entry in BE/B.Tech/ M.Sc.: __________________________ Year of Passing: ______________

GATE Score, if any _______________________________ Year_______________________________

Whether admitted earlier in this course, give details: ________________________________________

Date of Birth: ________________ Whether Employed: ___________ Whether Sponsored___________

Name of the Company_________________________________________________________________

Category: GEN SC ST PH

Statement of marks in Bachelor’s degree in Engg / Tech or M.Sc. examination:

Examination Semester / Part

SGPA CGPA Total marks obtained

Total marks of exam

Class/Div., % of marks

I

II III IV V VI VII VIII

Statement of marks in the following Examinations:

Examination Board/

University

Year of passing

Total marks obtained

Full marks of exam.

Grade/

GP

Class /Div.

% of marks Madhyamik or equiv.

(10)

HS or equivalent (10+2)

B.Sc.(Hons.) (10+2+3)

Diploma in Engg./

Tech

For Website Version form: C.U. Cash Challan No_________________ Date___________________

Or DD.No.________________ Date_____________ Issuing Bank_____________________________

(In reverse of DD, Please write the name and course applied for)

Self Attested

photo

WEBSITE VERSION

UNIVERSITY COLLEGE OF SCIENCE, TECHNOLOGY AND AGRICULTURE

1. Name of the applicant (in block letters)………

2. Calcutta University Registration No.(for C.U.Students)………..

3. Present address (if any) ………

………..

……… ……….

Telephone No……….……Mobile………..Email :………..

4. Permanent address . .……….

……….

………

……… Telephone No……….

5. Nationality ………. Domicile state ………

6. Male / Female ……….…… 7. Married / Unmarried……….

8. Father’s Name ………... Occupation ……….. Monthly Income ………….

9. Mother’s Name ………..… Occupation ……….. Monthly Income …………..

10. Husband’s /Wife’s name ……… Occupation ……….. Monthly Income …………

11. Guardian’s name, relationship and occupation ……….

12. Income of the family per month ………

13. Are you enjoying any scholarship or stipend (if yes, state the name of the sponsor) : ………

14. Details of employment (if employed)

……….

DECLARATION / UNDERTAKING

I do here by declare / undertake that the statements made above by me are true. If any error/misinformation is detected after my provisional admission, my admission shall be treated as cancelled. I have not taken admission nor shall I take admission to any other course during my studies in this University without intimation. If I get admission I will be a full time student of this University (not applicable for part-time courses). If I remain absent from the classes continuously for seven days or intermittently for more than 50% of classes held during any two consecutive weeks, my studentship will be terminated and my name will be automatically struck off from the rolls according to the admission rules of the University.

Endorsed

____________________________________ ___________________________________

Signature of Father/Mother/Husband/Guardian Signature of the Applicant

Date ………. Date ……….

N.B.

1. Application must be accompany attested copies of all relevant Mark Sheets and Certificates as applicable 2. For Sponsored candidates Employer Certificate in original must be attached to the application form.

3. Attestation by C.U. Senate/Syndicate Member, any University Teacher/Officer, Principal of any College, any Teacher of a College Affiliated to C.U. or Gazzetted Officer accepted.

4. All documents and photo submitted must be signed by the candidate himself/herself.

5. Incomplete Forms are liable to be rejected.

UNIVERSITY OF CALCUTTA

H A L L T I C K E T

Hall Ticket No._________

Admission Test for 3 Yr. (6 semester) Part time M.Tech. Course in Computer Science & Application for the Academic Session 2011-2012 under Sponsored Category

Name (In Block Letters) :___________________________________________

Address : _______________________________________________________

_________________________Ph.No./Mobile.No.:______________________

Signature of Candidate ; ___________________________________________

VENUE : University College of Science & Technology, 92, A.P.C. Road, Kolkata – 700009 .

Date : 5

^th

November, 2011 (Saturday)

Time : 12.00 Noon

^SECRETARY

Hall Ticket must be produced at the time of Examination UCSTA, C.U

UNIVERSITY OF CALCUTTA

H A L L T I C K E T

Hall Ticket No._________

Admission Test for 3 Yr. (6 semester) Part time M.Tech. Course in Computer Science & Application for the Academic Session 2011-2012 under Sponsored Category

Name (In Block Letters) :___________________________________________

Address : _______________________________________________________

_________________________Ph.No./Mobile.No.:______________________

Signature of Candidate ; ___________________________________________

VENUE : University College of Science & Technology, 92, A.P.C. Road, Kolkata – 700009 .

Date : 5

^th

November, 2011 (Saturday)

Time : 12.00 Noon

SECRETARY

Hall Ticket must be produced at the time of Examination UCSTA, C.U

Self attested stamp Size Photograph

Self attested

stamp Size

Photograph