For M. Tech.

Students

Visvesvaraya National Institute of Technology, Nagpur 440010

(For the record of Training and Placement Department)
I D No. ______________________

Merit No. _____________________

Roll No. : ____________________

(to be filled in by T&P Deptt.)

NOTE : 1. Please attach photo copies of the marklists matriculation onwards.

2. Any suppression of data will be viewed seriously.
3. Forms with incomplete information will be rejected.
4. Please attach, if applicable, caste cert. / validity cert. / recent Non Creamy layer cert. / PWD cert in Central Govt. format

1.
1.1
1.2

GENERAL
Name: __________________________
Surname

___________________________
First Name

Date of Birth :
Day

Month

____________________________
Fathers Name

1.3 Whether SC
PWD
D

Year

ST

OBC

Non creamy Layer

(If PWD Kind of Disability

Weight : _______ kg.

GATE % _____________________

1.4

Height : ______ cms.

1.5

Present Address : ____________________________________________________________________________

_____________________________________ PIN

1.6

Address for contacting: ________________________________________________________________________

(after annual examination) ______________________________ PIN
Phone (R) ______________________________

1.7

E-Mail Address : ________________________________ Mobile No._____________________ ___________

2.

EDUCATIONAL QUALIFICATIONS

2.1

Secondary and / or Higher Secondary

Examination
Passed

Board / Institution

Year of
Passing

Obtained

Marks
Out of (Total)

No. of Attempt
(s)

S.S.C. or
Equivalent
H.S.S.C. or
Equivalent
2.2

Graduation

Examination Passed

Institution / University

Year of

CPI / Grade /
Division

P
a
s
s
i
n
g

2.3

No. of Attempt
(s)

Post Graduation

Examination
Credits earned
Passed
1st Sem M.Tech.
2nd Sem M.Tech.
3rd Sem M.Tech.
4th Sem M.Tech.
Total
Present CPI : __________

Year of Passing

__

Grade
SPI
CPI

__

*A

*B

*C

__

*A No. of subjects Appeared in Re-exam

*B No. of subjects cleared in Summer Term Course
*C No. of subjects Appeared but not yet cleared ( core / elective )

Page 1 of 2

2.4

Title of Project in Final Year : ________________________________________________________

Name of Guide :

2.5

____________________________________________________________

Additional Qualifications, if any

____________________________________________________________________________________

3.

FAMILY BACKGROUND : Please provide full details since the employer usually needs this

Relations

Name

Age

Education

information for record.

Occupation if employed
(Specify Designation &
Office Address)

Annual
Income
(Approx)

Father
Mother
Brothers
Sisters
4.

PRACTICAL TRAINING
Have you undergone practical training ?

Yes

No.

If yes, provide details below

Sr. No.

5.

From

To

EXTRA CURRICULAR ACTIVITIES

Sr. No.

6.

Period

Name of Organisation

Name of Activity

Level of Participation :
College/University/District / State/
National

Year of Participation

ADDITIONAL INFORMATION, IF ANY

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Date : ------------------------

Signature ------------------------

Page 2 of 2