MEDI-CAPS UNIVERSITY

A.B. ROAD, RAU, PIGDAMBER, INDORE 453 331

Ph : (0731) 4259500, 4259502, 4259503, 4259539
Mob.No. : 9993570019, 9009928905, 9584832685
Email: info@medicaps-indore.ac.in

Date :
Name

:.....

Date of Birth

: .....

/2016

Telephone No. : .....

Mobile No

: .....

E-mail

: ...

ADMISSION REQUIRED: Please Tick Your Choice

B.TECH

: MECH
AUTO

CS

IT

CIVIL

EX

FIRE TECH.

Nano-Tech.

EI

Elec. Engg.

M-TECH

: EC

MBA

: CORE

MCA

: 2 Years 3 Years 5 Years

BBA

: 3 Years

B.COM

: 3 Years

BCA

: 3 Years

B.Sc. (CS)

: 3 Years

Diploma (Engg.) : CS

CS

EC

Marketing Mgmt.

EE

EC

MECH
Foreign Trade

MECH

CIVIL

JEE/C-MAT/CAT/GATE/PPT Roll No: ...

Marks Obtained in JEE/C-MAT/CAT/GATE/PPT: ..
Percentage of Marks Obtained in (10th) : ...
Percentage of Marks Obtained in (10+2) : ....
Percentage of Graduation: .....
Fee Details : CASH...Cheque No. .Cheque Amt. .........
DD No. DD Amt. ... E-Fees..
Remarks :

Signature of Parents

Signature of Candidate