ADMISSION TO THE II YEAR B.E. / B.TECH (for Diploma /B.Sc.) - MEPCO

[Kalyan]

MEPCO SCHLENK ENGG. COLLEGE, SIVAKASI


MEPCO ENGINEERING COLLEGE (PO) – 626 005

VIRUDHUNAGAR DISTRICT, TAMIL NADU
Phone : 04562-235000 (30 Lines); 235104 Fax : 04562-235111

Email : msec@mepcoeng.ac.in, mepcoeng@vsnl.com; Web : http://www.mepcoeng.ac.in/

APPLICATION FORM FOR ADMISSION TO THE II YEAR B.E. / B.TECH (for Diploma /B.Sc.)

Note: Information provided should be complete and accurate

Application No. :

Name (in Block letters with initials)

Gender ( ? ) Male Female
Marital status ( ? ) Single Married
Father/Guardian's Name & Occupation

Age & Date of Birth

Monthly Income of the Father/Guardian/ Other family members
Caste/Community/Religion/Nationality

Address (In capital letters)
Permanent For Communication



Phone / Mobile :

e-mail: Phone / Mobile:

e-mail:

Mother Tongue : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Place of Birth ___________________ ___________________ ___________________
District State
Native Place ___________________ ___________________ ___________________ District State

If any of your Relatives are studying in our : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
College, provide details

Details of Health :
a. Height : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Weight : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. Blood Group : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. General health Condition : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
e. Have you undergone any operation/ : . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . .
major health disorder. If so, give details . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Qualifying Examination :
Board of Study [?] : • State Board • CBSE • ICSE
• Others (specify) : . . . . . . . . . . . . . . . . . . . . . . . .
Marks obtained in the qualifying examination :
HSC Academic stream / Equivalent
Subjects Marks obtained Maximum Marks Percentage
(Marks Obtained / Max.marks x 100) Other Details
Maths (M)
HSC Reg. No : ........................................................
Year of Pass : ........................................................
Medium of
Instruction : .......................................................
Name of School last studied : .................................................................................
.................................... ............................................
Address of the School : .........................................
................................................................................
.................................................................................
Physics (P) &
Chemistry (C)
put together
HSC Total (out of 200)

Extra Curricular Activities, if any : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Any achievements (in Curricular, Co- & : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Extra Curricular activities) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Give your choice of branch : Preference 1 : . . . . . . . . . . . . . . . . . . . . . . . . . . .
Branches available : Preference 2 : . . . . . . . . . . . . . . . . . . . . . . . . . . .
a. B.E. – Civil Engineering Preference 3 : . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. B.E. – Electrical and Electronics Engg. Any available branch is
c. B.E. – Electronics & Communication Engg. acceptable (please ? )
d. B.E. – Computer Science and Engg.
e. B.E. – Mechanical Engineering
f. B.Tech – Information Technology
g. B.Tech – Biotechnology
*h. B.E. – Safety, Health and Environment Engineering
*subject to approval by AICTE and affiliation through Anna University
Date : Signature of the Applicant
Marks Obtained in :

DIPLOMA/B.Sc. (Admission for Second year B.E./B.Tech under Lateral Entry System)
Name and Address of the Polytechnic/ : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
College last studied
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name & Branch : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Register No. : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pre-Final Semester :(V Semester) Marks Final Semester :(VI Semester) Marks
Sl.No. Subjects Marks obtained Maximum Marks Percentage Sl.No. Subjects Marks obtained Maximum Marks Percentage
1. 1.
2. 2.
3. 3.
4. 4.
5. 5.
6. 6.
7. 7.
Total Total
Marks out of 200 : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(% of Pre-Final Semester + % of Final Semester)


Date : Signature of the Applicant



PARENTAL CERTIFICATE (for HSC students)
Attested copies of the following Certificates must be enclosed:
1. Higher Secondary Course Certificate (showing the marks)
2. Birth Certificate
3. Community Certificate
4. Secondary School Leaving Certificate
5. Any certificates of proficiency
6. Details of qualifying examination :
a. Qualifying Examination : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Name of the school / Institution last studied : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
with address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. University / Board : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. Number of appearance(s) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
e. Reg. No. with month & year of appearance(s):

i. First appearance : -------------------- --------------- ---------------
ii. Second appearance : -------------------- --------------- ---------------
(Reg. No.) (Month) (Year)
HSC Academic / Equivalent
Part I Tamil or
Other language : ______ out of ________
Part II English : ______ out of ________
Part III Maths :
Physics :
Chemistry :
Elective : ______ out of ________
______ out of ________
______ out of ________
______ out of ________
Total ______ out of ________

I agree to abide by the rules and regulations of the College / Hostel.
I hereby certify that information given above are true to the best of my knowledge. I am fully aware that if the details furnished are found to be incorrect at the time of checking after admissions, my son's / daughter's / ward's admission to B.E./B.Tech degree course can be automatically cancelled without any reference to me.

Date : Signature of the Applicant Signature of the Parent
PARENTAL CERTIFICATE (for DIPLOMA/B.Sc. students)
Attested copies of the following Certificates must be enclosed.
1. Diploma – V Semester and VI Semester Marks Certificate
2. Birth Certificate
3. Community Certificate
4. Secondary School Leaving Certificate / Polytechnic leaving certificate
5. Any certificates of Proficiency
6. Details of qualifying examination :
a. Qualifying Examination : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Name of the Polytechnic College last : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
studied with address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. Name of Examination Board . . . . . . . . . . . . . . . . .............................................
d. Reg. No. with month & year of appearance(s):
i. First appearance : -------------------- --------------- ---------------
ii. Second appearance : -------------------- --------------- ---------------
(Reg. No.) (Month) (Year)
DIPLOMA/B.Sc.
Pre Final Semester Final Semester
Sl.
No Subjects Marks Sl.
No Subjects Marks
i. ____out of ____ i. ____out of ____
ii. ____out of ____ ii. ____out of ____
iii. ____out of ____ iii. ____out of ____
iv. ____out of ____ iv. ____out of ____
v. ____out of ____ v. ____out of ____
vi. ____out of ____ vi. ____out of ____
vii. ____out of ____ vii. ____out of ____
Total Total
Percentage marks obtained (Prefinal + Final semester) : . . . . . . . . . . . . . . . . . . . . . . .

I agree to abide by the rules and regulations of the College / Hostel.
I hereby certify that information given above are true to the best of my knowledge. I am fully aware that if the details furnished are found to be incorrect at the time of checking after admissions, my son's / daughter's / ward's admission to B.E./B.Tech degree course can be automatically cancelled without any reference to me.

Date : Signature of the Applicant Signature of the Parent