Source of Info.

:
Name :
(First)

(Middle)

(Last)

Ph
o

Date of Birth :

to
gr
ap
h

Form No. :

Please Tick Desired Name :

a) Center of Piping & Process Engineering b) Centre for Mechanical Design and Engineering
c) Centre for Telecom Systems
d) Center of Lighting Technology
e) Centre of Mechatronics
f ) Centre for Project & Construction Management
f ) Centre for Automotive Design

Course Name :
Contact Details :
Mobile :
Email :

Permanent Address :

Telephone :
(O):

Communication Address:

Emergency Contact :
Name :
Permanent Address :

Mobile No. :
Landline :
Relationship With Applicant :
Project Undertaken at Graduation :

Address : South Block, MIT Campus, S. No. 124, Ex Servicemen Colony, Off Paud Road, Kothrud, Pune.(MH) - 411038

Details of Qualifying Examination:

Qualification

Stream

Year of Passing

% of Marks
Obtained in
Final Year

Name of
Institute/ University

Diploma
Graduate
Post Graduate

Working Experience :

Organization

Designation

Duration
From

To

Batch Commencement Date :

Document Checklist :
Mark sheet
SSC
HSC
All semesters of Diploma/Degree Engineering
Degree / Diploma Certificate
Two Photograph
Experience Certificate (for working participants)
Address Proof
Domicile certificate
Passport all pages xerox copy

Fees Payment Details :

Total Fees. :
Fees Paid :

1st Installment
2nd Installment

Date :
Date :

Undertaking :
I understand that the programmes under MITSkills are Autonomous Programs.
I agree to abide to all rules & regulations of MIT Skills, Pune
I agree not to divulge any information of training program to outside world
I agree that syllabus once taught will not be repeated if I am absent without prior information. The missed syllabus will be a self study for me. If I remain
absent for 10 consecutive days without prior notice, my admission will be automatically cancelled and I will have to re-admit myself for further training
I am fully aware that minimum 80% attendance is required for the successful completion of the course
I have noted that fees once paid will not be refundable or transferable
I am not assured / guaranteed of any type of job or any other sort of employment by MIT Skills & its employees . I am completely aware that campus
placement depends in my hard work & performance during the course & other paramenters like manpower requirement of the industry, companys
selection norm & their methods .
MIT Skills reserves the rights of admission or rejection of any candidate & also has the authority to modify the guidelines (rules & regulations) from time to
time for the betterment of the program.
All the information i have mentioned in this form is true to my knowledge & I take up the onus to prove it as & when demanded by institute.

Signature
(Name of Applicant)

For Office Use Only

Form Checked By :

Receipt No. :
Date :

Sign