S.NO.

____________

Merit No.__________

YMCA UNIVERSITY OF SCIENCE & TECHNOLOGY Sector 6, Faridabad-121006(Haryana)

(Established by Haryana State Legislative Act No.21 of 2009 & Recognized by UGC Act 1956 u/s 22 to Confer Degrees) APPLICATION FORM for PHYSICAL COUNSELING for ADMISSION AGAINST VACANT/ LEFTOVER SEATS IN B.TECH I Yr/B.Tech II Yr(LEET)/MBA/MCA/M.Tech./M.Sc (Sept,2011) Affix a Passport size Photograph (attested). Four Passport size photographs will also be required at the time of admission.

1. Admission for (B.Tech I Yr/ 2nd Year B.Tech.(LEET) . /MBA/MCA/M.Tech/M.Sc.(Math,Phy)(write one ) Branch wise option/choices a) b) c). d) e). f)

2.(a) Overall AIEEE Rank/OLET-LEET Rank/MAT Score/GATE Score/OLET- MCA Rank: (b) Relevant Roll No. (c) For B.Tech. I Year AIC OR HOGC (tick one)

3. Name of Full(in block letters) 4. Fathers Name(in block letters) 5. Mothers Name(in block letters) 6. Date of Birth

:_____________________________ _____________________________ :_____________________________ :_____________________________

7. Address for correspondence

:_____________________________ ..

E-Mail:..

Mobile

Tel

(Res)

8(a) D.D.No., Branch &Date of Rs 1000/-(new applicant only) _______________________ (b) Fee already deposited for earlier Physical Counseling at YMCAUST-2011(To be verified): Yes/ No

9. Details of Qualifying Examination passed:Examination with discipline Matric Year Marks Obtained Maximum Marks %age of Marks Name of School/College/ University

10+2

Diploma Graduation

9. Have you any gap year: . 10.Annual Family Income . 11.Specify reserved category(if any): (Attach reservation certificate)

DECLARATION BY THE CANDIDATE

I hereby solemnly affirm that all the entries made in this form are correct. I further declare that I fulfil the minimum eligibility conditions laid down for admission. In case of detection of any false entry, especially in respect of processing fee/qualifying examination/AIEEE Rank/OLET Rank / MAT/GATE score certificate, my admission may be treated as cancelled any time during the course of my study and I will no claim what-so-ever. I have noted merit prepared on the basis of AIEEE rank 2011 by YMCAUST available on notice board/website before admission. I have also noted that the University reserve the right not to fill any seat and decision of Registrar YMCAUST Faridabad will be final for my admission being held now. If any dispute arises, territorial jurisdiction will be Faridabad court. Certified that the above noted particulars are correct to the best of my knowledge and nothing has been concealed therein.

Signature of Applicant Signature of Parents Date:. Name of the candidate

FOR OFFICE USE(BY VERIFICATION COMMITTEE) Discrepancy , if any: 1. 2. 3. Signature of verification committee: 1 2.. 3 )( )( )

Name of verification committee members (

FOR USE OF ADMISSION COMMITTEE ONLY

Overall AIEEE Rank(for BTech 1 year only)..
st

On the basis of above , Verification committee report, Mr./Ms Is hereby admitted provisionally in 1st semester in .branch under ..category in B.Tech. course/ Signature of admission committee members 1.23.4 Name1.234 . for the session 2011-12 at YMCAUST, Faridabad.

(CHAIRMAN ADMISSION COMMITTEE)

FOR USE OF ACCOUNTS BRANCH ONLY Fee of Rs.35,582/-(Rupees Thirty Five Thousand Five Hundred Eighty Two Only)vide demand draft No. . Datedin the favour of Registrar, YMCAUST Faridabad payable at Faridabad received vide university receipt no..dated

CASHIER
List of documents, which should be attached to the Application Form a) Attested photo copy of 10th certificate showing date of birth. b) Attested photocopies of Certificates/Marks Sheets of 10+2. c) Attested photocopies of qualifying Degree certificate & others as applicable. d) Gap year certificate, if any e) Attested Copy of AIEEE Rank Card &Admit Card/OLET Rank/HSCS Rank/MAT Score/GATE Score/Others as applicable f) Character Certificate from Head of Institution last attended. g) Medical Fitness Certificate from a Govt. Medical Officer(Original). h) Already admitted candidates must submit attested copy of earlier admission letter only.