Vivekananda Institute of Technology (East)

Affiliated to Rajasthan Technical University, Kota & Approved by AICTE

Application form for Provisional Admission in B.Tech (Session 20…… -20…….)

Form No. USN…………………………….. Date………………………….

1.Name of the Student(In Full)…………………………………………………………………………………………………………………………………………………………….

2.Date of Birth ……………………………………………………..(Age: …………………………….Years……………………………….Months ………………………………)

3.Sex (Male/Female)…………………………………4. Category: Gen/ST/SC/OBC/PH…………………………. Caste& Religion………………………………….

5. Father’s Name…………………………………………………………….Guardian’s Name………………………………………………………………………………………….

Mother’s Name…………………………………………………………………………………………………………………………………………………………………………………

6. Permanent Residential Address………………………………………………………………………………………………………………………………………………………...

Student Mobile No. : ………………………………………………………..E-mail ID……………………………………………………………………………………………….

7. Father’s Occupation (Describe fully)………………………………………………………………………………………………………………………………………………….

8. Father’s Office Address……………………………………………………………………………………………………………………………………………………………………..

……………………………………………………………………………………………………Tel. /Mob. No. (With STD code)…………………………………………………..

9. Educational Qualifications:

S.No. / NAME OF EXAM / YEAR OF PASSING / BOARD/UNIVERSITY / SUBJECT / Percentage/CGPA
Aggregate / P.C.M.
1. / XTH
2. / XIITH
3. / Other
4. / Diploma /B.Sc.

10. Hostel Facility Required: Yes/ No.

11. (Hobbies, Games, Athletics, etc…)………………………………………………………………………………………………………………………………………………………

12. Address for Communication:

Local guardians’ residential address Present Local Address

……………………………………………………………………………………………. …………………………………………………………………………………….

…………………………………………………………………………………………….. …………………………………………………………………………………….

…………………………………………………………………………………………….. …………………………………………………………………………………….

Tel. / Mob. No,…………………………………………………………………….. Tel. / Mob. No……………………………………………………………….

E Mail:………………………………………………………………………………….Email:……………………………………………………………………………

FOR OFFICE USE ONLY:

  1. Institute Roll No. ………………………………………………………………………………………………………………………………………………………………………………
  2. Branch………………………………………………………………………………………………………………………………………………………………………………………………
  3. Fee Received Rs………………………………………………………………………………………………………………………………………………………………………………..
  4. Fee Receipt No. ……………………………………………………………………………….. Date……………………………………………………………………………………..
  5. Hostel Requirement (Yes/No)…………………………………………………………………………………………………………………………………………………………..

DECLARATION

(By Student and His / Her Father/ Guardian)

1.I do solemnly affirm that statement and information furnished by me overleaf ( as also in the enclosures submitted) are true. I declare that if any information furnished there in is found to be untrue in material/ particulars. I shall be solely responsible for cancelation of my admission and legal action.

2.I also undertake to pay tuition fee, hostel fee and other dues regularly. Fees once paid will not be refunded.

3.I promise to abide by all the rules & regulations of the Institute as well those of the State Govt. Technical Education Department/ Institute concerning fee structure, examination, attendance, practical training etc. at present in force as well as those that may be made/modified from time to time.

4.I also undertake to attend minimum of 75% of classes in all the subjects, otherwise I may be debarred from all the internal/external exams.

5.I also understand that the following will be deemed as acts of indiscipline:

a.Noncompliance of Institute and Hostel orders and notices.

b.Noncompliance of orders and instructions of management, faculty and staff members.

c.Involvement in RAGGING (As per the directive of the Hon’ble Supreme Court, Ragging in any form by the student will result in immediate disciplinary action). Student found guilty may be summarily expelled from the Institute/ Hostel and F.I.R. will be lodged with the police.

d.Absence from classes and hostel for more than seven days without prior permission.

e.Irregularity in attendance, in payments of Institute and hostel dues and in any other related matters.

f.Misuse or destruction of Institute and hostel property.

g.Provoking student to take part in strikes, Morchas or formation of Union/Association; the objective of which is directly or indirectly political or communal.

h.Arrange meetings or inviting some people to address any meeting in the Institute/ Hostel premises without prior permission of the institute Management.

i.Use of drugs/alcohol in the Institute/Hostel/ Institute activities.

j. Involvement in acts against court of law.

k.Involvement in mass bunking from classes.

6.I also understand that if I am found involved in any act of indiscipline, I will be liable to any one or more of the following punishment:

a.Warning to me and my father/ guardian by the Institute Management.

b.Deduction of marks or monetary fine or both.

c.Reduction/ cancellation of scholarships/ stipend/fellowships.

d.Recovery in part or full of losses or damages to the Institute/ Hostel property of others.

e.Suspension from availing any of the Institute amenities and services or from classes.

f.Removal/ rustication or expulsion from Institute and/or Hostel.

g.Withholding of character certificate.

7.I also declare that:

a.I have not been convicted of any criminal offences, nor have been released on bail in connection with a criminal case.

b.No case of criminal offence or moral turpitude is pending against me in any court of law.

c.No complaint or F.I.R. has been lodged against me by the Institute/Principal of Constituent Institute/Affiliated University or by any other competent authority.

d.I have not resorted to any act of indiscipline during the previous years.

8.I also understand that in case of any dispute between me/my father/ guardian and Institute, only the court of Jaipur will have the sole jurisdiction.

Place: Signature of Student Signature of Father/Guardian

Date:

UNDERTAKING BY PARENT/ GUARDIAN

(Session 20………-13………)

  1. I ……………………………………….………………………….. S/o, D/o Sh………………………………………………………………………………………. testify that my son / daughter/ward…………………………………………………………………………………. is seeking admission with my consent and I am personally responsible to the Institute for payment of all his/her dues that College Management may decide from time to time as per Rajasthan Govt. notification. I assure that the application will abide by all the rules of the University as laid down by the Institute from time to time.
  2. I have read the rules and regulation and I understand that my son/daughter/ward has to undergo obligatory practical training for specified periods in accordance with the relevant academic curriculum. I agree that in the event of my ward being placed in an industrial training within or outside Jaipur, for such practical training, the Institute will not be held responsible for any mishap that may occur during his/ her tenure with the Institute.
  3. I, do hereby certify that the particulars submitted by son /daughter /ward are correct.
  4. I further testify that I shall not raise any objection if my ward is rusticated from the Institute due to his /her participation in any union /unlawful activity.
  5. I understand that the security deposit /caution money; if, any, given at time of admission will not be refunded if my ward discontinues the course in between or withdraws prematurely from his/her course.
  6. My ward will attend his /her class regularly and maintain 75% attendance separately in each theory/ tutorial/ laboratory class as required by the institute. I understand that he may be detained in internal/external exams, if his /her attendance falls below 75%.
  7. I shall remain in touch with the Institute regularly and it is my responsibility to obtain feedback about my ward from the Institute from time to time.
  8. I shall inform the Institute without delay in case there is any change in my address and/or telephone number.

Date: Signature of Parent/Guardian

Place: Name:

Address:

UNDERTAKING BY THE STUDENT

(Session 20………-20………)

  1. I ……………………………………………………………………………………………………S/o, D/o Sh……………………………………………………………………………………. hereby certify that the particulars submitted by me are correct and I agree that the admission may be cancelled and tuition fee, security deposit/ caution money paid by me forfeited, if any of the particulars given by me at the time of admission are found to be concealed, false or incorrect.
  2. I also understand that my admission will be confirmed after verification of documents submitted by me in original and my fulfillment of eligibility criteria as mentioned in the ordinances and also indicated in University website.
  3. I agree that the decision of the institute management in all matter concerning admission, studies, attendance, discipline and conduct etc. will be final and binding upon me.
  4. I understand my association active or passive with any political organization, students, union, etc. is forbidden.
  5. I understand that the consumption of alcohol, smoking, drugs or any other intoxicant within the institute premises/ hostel/ colony/Institute activity is forbidden.
  6. I agree that if any time fee structure is revised/enhanced, by the competent authority/ state govt. the revised/enhanced amount would be deposited by me to the institute within 15 days of such notification.
  7. I agree that the institute shall have the right to forfeit any security deposit inter alia on the ground of my failure to claim the refund within one year of my passing out/ceasing to be on the rolls of the institute.
  8. I agree that in the event of any breach of the aforementioned undertaking, my admission may be cancelled without any obligation on the institute to issue me a notice. In such an instance, any fee deposited by me, shall stand forfeited.

Date: Signature of Student

Place: Name:

Address:

VIT Campus, Sector-36, NRI Road, Sisyawas, Jagatpura, Jaipur, Rajasthan, Pin-303012, Phone No: 0141-4077999, Fax No: 0141-4077900

E-Mail: Website: , Toll Free No. 1800-3-13-14-15