VISVESVARAYA NATIONAL INSTITUTE OF TECHNOLOGY NAGPUR 440 010

APPLICATION FORM FOR ADMISSION TO M.Sc. (Physics/Chemistry/Mathematics) Programme 2013-15

JAM qualified: YES/ NO Mark tick (!) appropriately

JAM Score :
(Submit separate application form for each M.Sc. programmme)

Paste a recent Self-Attested Passport-Size Photograph here

Program applied for: M.Sc. in ________________________ 1. Full Name : _________________________________________ 2. Date of Birth: ______________3. Sex: Male/Female_________ 4. Nationality: _________________________________________ 5. Fathers Name: ______________________________________ 6. Mothers Name: ______________________________________
Mark tick (!) in appropriate Box Category * (A) General (B) OBC (C) SC (D) ST

7. Address for Correspondence: ___________________________ _____________________________________________________ _____________________________________________________ _____________State: ______________Pin Code:____________ E-mail address: _______________________________________ 8. Phone No. (with STD Code): Mobile Phone No. :

(E) OM (F) PWD

9. Details of Demand Draft: a) Rs. 300/ 150 No. .. Dated:

/ 2013

(Rs. 300/- for General and OBC/OM candidates and Rs. 150/- for SC/ST/PWD candidates.) b) Bank & Branch issued______________________________________ City ____________ 10. Educational Qualifications: Degree B.Sc. I year B.Sc. II year B.Sc. III year*
*If the candidate appeared for B.Sc. III year examination and the result is awaited then write Result Awaited in the marks column. However, candidate has to submit the final result at the time of admission.
Application Form-M..Sc, Admissions-2013,VNIT, Nagpur

University/Institute, Place and State

Subjects

Year

Marks % Aggregate or Grade % or Grade

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Declaration by the applicant: Certified that all information provided by me in this form is correct to the best of my knowledge and belief. I understand that any willful misrepresentation of facts will result in cancellation of my candidature for written entrance test/admission and liable to be dismissed. If admitted, I shall abide by all the rules and regulations of the institute. Date: / / Applicants Signature_______________________

12. CHECKLIST: ENSURE THAT FOLLOWING ARE ENCLOSED WITH THE APPLICATION FORM T ICK (!)
i. The Demand draft for Rs. 300/150 in favour of Director, VNIT Nagpur payable at Nagpur ii. Attested photocopy of High School (X Std.) Certificate for date of birth iii. Attested photocopy of SC/ST/OBC/Minority/ PWD certificate, if applicable iv. Attested photocopies of mark/grade sheets of Intermediate and B.Sc.

v. Proof of appearing B.Sc. final examination vi. Attested photo copy of JAM score card ( if applicable) The Application Form (hard copy), complete in all respect must reach at following address by 16th May, 2013 till 5:00 PM. Address for Correspondence: To Dr. J.D. Ekhe Chairman, MSc-Admisions-2013 Department of Chemistry, Visvesvaraya National Institute of Technology, Nagpur 440 010. Phone: 0712-2801602, 0712 - 2801404 Email: mscadm2013@vnit.ac.in

* Category : OBC- Other Backward Classes SC - Scheduled Caste ST Scheduled Tribe OM- Minority PWD Persons With Disabilities Note: JAM qualified candidates need not appear in the written entrance test. However, this form should be submitted by the all candidates interested in M.Sc. admission.

Application Form-M..Sc, Admissions-2013,VNIT, Nagpur

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