The Maharaja Sayajirao University of Baroda FACULTY OF TECHNOLOGY & ENGIENERING Department of Architecture

D.N. Hall, Pratapgunj, Vadodara 390 002.

APPLICATION FORM FOR ADMISSION TO THE POST GRADUATE DEGREE COURSE IN MASTER OF CITY PLANNING
ELIGIBILTY REQUIREMENT : 1. Name of the Candidate (in block letters) Surname : ___________________________________________________ Name : _____________________________________________________ Fathers/Husbands Name : _____________________________________ 2. Have you passed B. Arch. / B. E. (Civil) / M.A. (Geography, Economics) Yes No

LAST DATE OF RECEIVING THE FORM BY THE DEPARTMENT OF ARCHITECTURE OFFICE 14th August 2012 upto 2.00 p.m.
-----------------------------------FORM FEES : RS. 1000/-

AFFIX Recent Passport size Photograph here (50 mm x 35 mm)

If yes, Name of the Degree of last qualifying examination and year of passing as regular student : _____________________________________________ 3. 4. Percentage of Marks at same as above. Final year: ____________________ Have you appeared for GATE : Yes No

(Signature of the Head of the last Institute attended or first class gazette officer should be across the photograph)

If yes, GATE Score: __________________ valid upto ________________________ REGION AND OTHER INFORMATION 1. Details of the last Institution attended Name : ___________________________________________________________________________ Place : _________________ District : __________________ State : ___________________________ 2. (a) Are you applying for admission under Reserved Seats ? If yes, please tick the appropriate box. Attach a copy of School Leaving Certificate and Caste Certificate issued by a competent authority of Gujarat State. In addition to Caste Certificate, SEBC applicants must also attach a Non Creamy Layer certificate issued by the competent authority of the Gujarat State, for the current year. Schedule Caste (SC) Socially and Educationally Backward Class (SEBC) (b) Schedule Tribes (ST) Others (Specify) _____________________________ Yes No

Are you applying for Admission under Physically Handicapped category ? If yes, attach necessary certificate issued by Competent Authority.

PERSONAL DATA 1. 2. Name in Full : ______________________________________________________________________ (in BLOCK letters) (Surname) (Name) (Fathers/Husbands Name) Address for correspondence : __________________________________________________________ __________________________________________________________________________________ Pin Code No.: ______________ Ph./Mobile No.: _________________ e_mail : ___________________ 3. Permanent Address : _________________________________________________________________ __________________________________________________________________________________ __________________________Pin Code No.: ______________ Ph./Mobile No.: _________________

4.

Date of Birth : __________________ Age : ______________ Place of Birth : ______________________________________________________________________ Place District State Nationality : ___________________________________ Foreign Students should give their Passport No.: ___________________________________________ Type of Visa and its expiry date : ________________________________________________________

5.

6. 7.

Sex :

Male

Female

8. Mother Tongue : ________________________________

Specialization at the undergraduate: ____________________________________________________ __________________________________________________________________________________ Specialization at Post graduate : ______________________________________________ __________________________________________________________________________________

9.
11.

Do you require Hostel accommodation :

Particulars regarding examination* passed:

Yes

No

For Bachelor Degree obtained :

Particulars Name of the University / Examination Body Year of Passing No. of attempts for passing Marks Obtained / Out of % in the aggregate Class obtained

H.S.C. B. Arch. I / B.E. (Civil) I / B.A. I B. Arch. II / B.E. (Civil) II / B.A. II B. Arch. III / B.E. (Civil) III / B.A. III B. Arch. IV / B.E. (Civil) IV B. Arch. V

For Master Degree obtained :

Particulars Name of the University / Examination Body Year of Passing No. of attempts for passing Marks Obtained / Out of % in the aggregate Class obtained

First Year Post Graduate Second Year - Post Graduate

Any other Educational Qualification :

Particulars Name of the University / Examination Body Year of Passing No. of attempts for passing Marks Obtained / Out of % in the aggregate Class obtained

* Please attach attested copies of Statements of Marks for all the examinations. 12. Professional Experience, if any : Designation and nature of duties Period with dates

Name and address(es) of employer(s) mention the present employer in the last line

13.

Medical Certificate of Physical Fitness : I Certify that I have examined Shri/Kum/Smt. _____________________________________________ and I find that his/her eyesight is good and that any minor defects in the same can be overcome by means of suitable glasses, that he/she is physically fit for admission to the Faculty of Technology & Engineering. Further he/she has no bodily disease or mental infirmity making him/her unfit now or likely to make unfit for work in the workshop or for active outdoor service in his/her field. Place : ________________________ Address : ______________________ ______________________________ ______________________________ Signature : ____________________________ Qualifications _________________________

14.

I have read the prospectus and I hereby agree, if admitted, to conform to the rules and regulations at present I force or that may hereafter be made by the administration of the University and I undertake that so long as I am student of the University, I will do nothing unworthy of a student of the University or do nothing that will interfere with its orderly working and discipline. I give below the necessary particulars. Date : Signature of the applicant (d) __________________________________ (e) __________________________________ (f) __________________________________

15.

List of Certificates (True copies) attached (a) ____________________________________ (b) ____________________________________ (c) ____________________________________ Note : Please read the general rules given overleaf.

GENERAL RULES GOVERNING THE CONDUCT OF STUDENTS IN THE UNIVERSITY

1.

A student must do nothing either inside or outside the University that will interfere with its orderly governance and disciplines. This comprehensive rule converts most cases that are likely to arise. It forbids, for instance : (a) Impolite or unseemly behavior in class-room or in University premises during working hours of the College and the Faculty. (b) Attempt to persuade other students to absent themselves from regular classes. (c) Damage to or defacement of University furniture, fittings and property. (d) Disobedience of notifications or instructions issued by the Principals, Deans, Heads of the Departments and Member of the Staff duly authorized.

2.

No Society in any Faculty or College may be formed and no person may be invited to address any existing society or meeting, without the previous permission of the Head of the Institution concerned. Students are required to be regular in attendance. If unavoidable absent on account of health, urgent private affairs or other reasons, they must be prepared to state the exact reasons for absence and produce necessary certificate. Students are expected to behave with courtesy towards the members of the staff, their fellow students are all visitors to the Institution.

3.

4.

FOR OFFICE USE 1. 2. Eligibility Requirements fulfilled Yes No

Merit list Requirement : ____________________________________________________________ (i) Academic score : _______________________ (ii) Interview : __________________________ Total of (i) & (ii) : _______________________

3. 4. 5.

Admission

Yes

No _____________________ (SC/ST/SEBC/NTDNT/PHY/Other specify)

Waiting List No.: _________________________ If admitted later : _________________________ All required documents submitted : Original Certificate Migration Certificate Eligibility Certificate Transfer Certificate SC/ST/SEBC Certificate/Non cremalyer Certificate etc. School leaving Certificate Fee Paid on : _________________________

ACKNOWLEDGEMENT
(to be filled by office)
Date : An application for Master of City Planning Self Financed Course received from Mr. / Mrs. / Kum. ______________________________________ with Demand Draft No. __________________ dtd.: __________________ of _______________________ Bank.

For Director PG-Planning (SFC) Department of Architecture Faculty of Technology & Engineering