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    Sekh 1

    Uploaded by

    Sekhar Murmu

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    © All Rights Reserved
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    Sekh 1

    Uploaded by

    Sekhar Murmu
    14 views2 pages

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    Sekh1

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    Copyright:

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    14 views2 pages

    Sekh 1

    Uploaded by

    Sekhar Murmu

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    © All Rights Reserved
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    You are on page 1of 2

    MPC AUTONOMOUS COLLEGE, TAKHATPUR, BARIPADA

    APPLICATION FORM FOR ADMISSION TO B. Sc. ITM (U.G.) / B . S c . ( H o n s . ) D a t a S c i e n c e (U.G.) /


    M. Sc. Computer Science (PG) / PGDCA COURSES: 2023-24
    (FOR OFFICE USE ONLY)
    INDEX NO. COLLEGE ROLL NO. SUBJECT

    Affix
    Signature of the OIC, Admission Signature of the Principal

    Photo Here
    Applicant Information : To be filled by Candidates
    APPLIED SUBJECT* Mention clearly in Right Hand Side
    Name of the Applicant in
    Capital Letter*
    DOB DD MM YYYY Mother Tongue
    Gender(M/F) Blood Group
    Religion Contact No*
    Category Email Id*
    (Category Type:- ST,SC,OBC, PwD, ESM,SDP)

    (Bank Draft Details)


    B.D. No Bank Name Date Amount

    Address
    Correspondence Permanent
    Name: Name:
    C/O: C/O:
    At: At:
    Po: Po:
    District District
    State State
    Pin : Pin :

    Academic Records (Last attended)


    Name of board Year of Mark
    Sl. Name of Exam Name of Institute Total Mark
    Passed Passing secured
    No

    01 *H.S.C.

    02 *+2 or
    Equivalent
    03 +3 or
    Equivalent

    If Hostel Accommodation required (Yes/No)

    * Stands For: - Mandatory Filled


    Page 1 of 2
    Parents / Guardian information
    Name of the Father: - Contact No:-

    Name of the Mother:- Contact No:-


    Name of the Guardian
    Contact No:-
    ( If Parents not alive):-
    UNDERTAKING

    I do hereby agree to abide by the rules of the College/ Hostel. I undertake that should any indiscipline and
    disobedience instance of the rules laid down by the Government or any authority empowered by Govt. in this
    regard or should conduct in the college is found not satisfactory, my name will automatically be removed from
    the college. I undertake that information furnished by me in this application is true and correct and I undertake
    that any wrong information furnished by me, detected afterwards will be treated as cognizable offence.

    I further undertake that I will not involve in any ragging activities in the college and hostel premises. I
    understand that criminal case will be filed against me if indulge in ragging.

    I hereby fully endorse the undertaking made by our Submitted by me


    Child / ward

    Signature or thumb impression of parents/ guardian Full Signature of Applicant


    Date _ Place Date Place

    Enclosures (The Following documents would enclosed along with Application Form)
    Sl.# Documents Remarks
    01 Original Bank Draft.
    02 Self-attested Photocopy of HSC/ Equivalent examination certificates.
    03 Self-attested Photocopy of CHSE/ Equivalent examination mark sheet & certificates.
    04 Self-attested Photocopy of degree/ Equivalent examination mark sheet & certificates in
    case for applying PG Courses.
    05 Self-attested Photocopy of certificates in support of reservation
    06 Self-attested Photocopy of Permanent Resident certificate if applicable.
    07 A self-addressed envelope of 10*11 cm in Size.
    08 Self-attested Passport Size Photographs

    Page 2 of 2

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