Website Version

For Office use Form No…………………

Recommended for admission Sold by ………………..
Head of the Department/
Course Co-ordinator Self
Attested
photo

UNIVERSITY OF CALCUTTA
UNIVERSITY COLLEGE OF SCIENCE, TECHNOLOGY AND AGRICULTURE
APPLICATION FORM FOR ADMISSION TO FIRST YEAR M.TECH./M.PHIL. COURSES

To
The Secretary
Faculty Councils for P.G. Studies in Sc., Tech.& Engg and Ag. & Vet. Sc.
Calcutta University
92, A.P.C. Road, Kolkata – 700 009

Name of the Applicant (in block letters): __________________________________________________

Applied for Admission in Course: ____________________________Session:__________________
Subject: ____________________________________________________
Bachelor’s Degree in Engg./Tech. or M.Sc. with Subject: _____________________________________
College and University: _______________________________________________________________
Year of Entry in BE/B.Tech/ M.Sc.: __________________________ Year of Passing: ______________
GATE Score, if any _______________________________ Year_______________________________
Whether admitted earlier in this course, give details: ________________________________________
Date of Birth: ________________ Whether Employed: ______________________________________
Category: GEN SC ST PH
Statement of marks in Bachelor’s degree in Engg / Tech or M.Sc. examination:
Examination Semester SGPA CGPA Total marks Total marks of Class/Div., %
/ Part obtained exam of marks
I
II
III
IV
V
VI
VII
VIII

Statement of marks in the following Examinations:

Examination Board/ Year of Total marks Full marks Grade/ Class %
University passing obtained of exam. GP /Div. of marks
Madhyamik or equiv.
(10)
HS or equivalent
(10+2)
B.Sc.(Hons.)
(10+2+3)
Diploma in Engg./
Tech

For Website Version form: C.U. Cash Challan No_________________ Date___________________

Or DD.No.________________ Date_____________ Issuing Bank_____________________________
(In reverse of DD, Please write the name and course applied for)
 WEBSITE VERSION

UNIVERSITY COLLEGE OF SCIENCE, TECHNOLOGY AND AGRICULTURE

1. Name of the applicant (in block letters)………………………………………………………………………………

2. Calcutta University Registration No.(for C.U.Students)……………………………………………………………..
3. Present address (if any) ………………………………………………………………………………………………
……………………………………………………………………………………………..
…………… ………………………………………………………………………………….
Telephone No……………….……Mobile………………………………..Email :…………………………………..
4. Permanent address . .………………………………………………………………………………………………….
…………………………………………………………………………………………………….
……………………………………………………………………………………………………
……………………………………………………… Telephone No…………………………….
5. Nationality ……………………………………. Domicile state ……………………………………………………
6. Male / Female …………………………….…… 7. Married / Unmarried……………………………………….
8. Father’s Name …………………………………………... Occupation …………….. Monthly Income ………….
9. Mother’s Name ………………………………………..… Occupation …………….. Monthly Income …………..
10. Husband’s /Wife’s name ………………………………… Occupation …………….. Monthly Income …………
11. Guardian’s name, relationship and occupation …………………………………………………………………….
12. Income of the family per month …………………………………………………
13. Are you enjoying any scholarship or stipend (if yes, state the name of the sponsor) : …………………………………
14. Details of employment (if employed)

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

DECLARATION / UNDERTAKING
I do here by declare / undertake that the statements made above by me are true. If any error/misinformation is detected after
my provisional admission, my admission shall be treated as cancelled. I have not taken admission nor shall I take admission
to any other course during my studies in this University without intimation. If I get admission I will be a full time student of
this University (not applicable for part-time courses). If I remain absent from the classes continuously for seven days or
intermittently for more than 50% of classes held during any two consecutive weeks, my studentship will be terminated and
my name will be automatically struck off from the rolls according to the admission rules of the University.

Endorsed

____________________________________ ___________________________________
Signature of Father/Mother/Husband/Guardian Signature of the Applicant

Date ……………………. Date ………………….

N.B.
1. Application must be accompany attested copies of all relevant Mark Sheets and Certificates as applicable
2. For Sponsored candidates Employer Certificate in original must be attached to the application form.
3. Attestation by C.U. Senate/Syndicate Member, any University Teacher/Officer, Principal of any College, any
Teacher of a College Affiliated to C.U. or Gazzetted Officer accepted.
4. All documents and photo submitted must be signed by the candidate himself/herself.
5. Incomplete Forms are liable to be rejected.
 RECEIPT PAGE
WEBSITE VERSION

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

Form No……………

University Colleges of Science, Technology and Agriculture

University of Calcutta

Received the application form without verification from…………………………………..............

for the course………………………Subject……………………………………………………….

Date: Signature
 UNIVERSITY OF CALCUTTA
HALL TICKET Self attested
Hall Ticket No._________ stamp Size
Photograph
Admission Test for 2 Yr./3 Yr. M.Tech. Courses, 2009

Name (In Block Letters) :___________________________________________

Address : _______________________________________________________

__________________________Ph.No./Mobile.No.:______________________

Signature of Candidate ; ___________________________________________

VENUE : University College of Science & Technology, 92, A.P.C. Road, Kolkata – 700009

Date of Examination : 21.05.2009

2Yr. M.Tech in Elect. Engg. / 3Yr. M.Tech in Elect. Engg. (Elect. Power) Time..12 Noon to 1 P.M.

2Yr. M.Tech in Inst & Control. Engg. / 3Yr. M.Tech in Inst & Control. Engg Time..2P.M. to 3 P.M.

SECRETARY
Hall Ticket must be produced at the time of Examination UCSTA, C.U

UNIVERSITY OF CALCUTTA
HALL TICKET Self attested
Hall Ticket No._________ stamp Size
Photograph
Admission Test for 2 Yr./3 Yr. M.Tech. Courses, 2009

Name (In Block Letters) :___________________________________________

Address : _______________________________________________________

__________________________Ph.No./Mobile.No.:______________________

Signature of Candidate ; ___________________________________________

VENUE : University College of Science & Technology, 92, A.P.C. Road, Kolkata – 700009

Date of Examination : 21.05.2009

2Yr. M.Tech in Elect. Engg. / 3Yr. M.Tech in Elect. Engg. (Elect. Power) Time..12 Noon to 1 P.M.

2Yr. M.Tech in Inst & Control. Engg. / 3Yr. M.Tech in Inst & Control. Engg Time..2P.M. to 3 P.M.

SECRETARY
Hall Ticket must be produced at the time of Examination UCSTA, C.U