Visvesvaraya Technological University

“Jnana Sangama”, Belgaum – 590014, KarnatakaState

Application Fee: Rs.100

APPLICATION FORM FOR ADMISSION TO MASTER OF TECHNOLOGY

(Part – Time QIP) Programme in Thermal Power Engineering

EXTENSION CENTRE: SIDDAGANGA INSTITUTE OF TECHNOLOGY, TUMKUR

  1. Name of the Candidate in Full:

(As per university marks card in block letters)

  1. Date of Birth:
  2. Sex:
  3. Address of the Candidate for correspondence:

Name:

Address:

Phone:

Mobile:

E-mail:

  1. Address of the Sponsoring Institute:

including phone numbers

  1. Details of academic Record of Qualifying

Examination

  1. Qualifying Degree:
  2. Branch of Engineering/Specialization :
  3. Name of the College:
  4. University:
  5. University Reg. No.:

Sl.No. / Particulars of Qualifying
Examination Passes / Max. Marks / Marks obtained / Office use
I year / I semester
II semester
II year / III semester
IV semester
III year / V semester
VI semester
IV year / VII semester
VIII semester
V year / IX semester
X semester
Total / % Marks
  1. Details of Professional Experience (Attach relevant document)

Name of the Employer / Nature of Organization (Govt./Semi Govt./Private) / Post Held / Date of Joining / Date of Leaving / Length of Service
  1. NO OBJECTION CERTIFICATE

(Note: Get it forwarded in the application form itself, do not attach No Objection Certificate)

The undersigned is pleased to permit Mr./Ms______

who is working in this organization from ______(DD/MM/YY) and presently holding the rank/position of ______for pursuing the M.Tech programme in Thermal Power Engineering (Part-Time QIP) course. The candidate will be allowed to be present at the institute as required by the academic schedule for a period of three years and will be in service till the completion of the course.

Organization: Govt./ Semi Govt./ Private

Firm Registration No.______(incase of private)

Signature of the Head of the Institution / organization

with date and seal

  1. List of Enclosures: (Photo copy only)
  2. Statement of marks of SSLC / Class X or DOB proof
  3. Marks list of each semester / year of qualifying degree
  4. Demand draft of requisite amount
  5. Certificate of professional experience

DECLARATION BY THE APPLICANT

I declare that all the information given by me is true and authentic to the best of my knowledge and belief. If I am admitted on the basis of incorrect / false information, I agree that, VTU reserves the right of prosecution and cancellation of seat without notice.

Place:

Date: Signature of the Applicant

FOR OFFICE USE ONLY

Aggregate % of all the examination of degree______

Eligible / Not Eligible

Co-ordinator’s signature