MEPCO SCHLENK ENGG.

COLLEGE, SIVAKASI

A4

MEPCO ENGINEERING COLLEGE (PO) 626 005

VIRUDHUNAGAR DISTRICT, TAMIL NADU

Phone : 04562-235000 (30 Lines); 235104 Fax : 04562-235111

Email : msec@mepcoeng.ac.in
Web : http://www.mepcoeng.ac.in/

APPLICATION FORM FOR ADMISSION TO THE

M.E. / M.TECH DEGREE COURSES
Note: Information provided should be
complete and accurate

Application No. :

Passport Size
Photograph

Please enclose a DD for Rs.550/- along with the filled in application form,
drawn in favour of Mepco Schlenk Engineering college, payable at Sivakasi.
Date

Name of the Bank

Draft Number/Cash receipt No.

Value

(Do not provide any

computer printed
photograph)

Please mark 9over the appropriate box

Note :

GATE
General
Sponsored ( Full time / Part-time)
SC/ST
i. Sponsored candidate's application is to be forwarded by the employer.
ii. SC/ST candidate should attach the attested copy of caste certificate.
iii. All candidates should attach Xerox copies of mark sheets, degree certificate and experience certificate (if any).

Category of the Applicant :

Programme for which you are applying :

(Separate application form to be submitted for each course). Please 9 the appropriate box.
M.E. Communication Systems
M.E. Power Electronics and Drives
M.E. Computer Science and Engineering
M.E. Industrial Safety Engineering
M.E. Structural Engineering
M.Tech.-Nano Science and Technology
M.E. CAD / CAM
M.Tech. Bio Technology*
*subject to approval of AICTE and affiliation by Anna University

Qualifying Degree & Branch : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FOR OFFICE USE
Name of the Candidate

...................................................

Course and Department applied :

...................................................

Percentage of marks

...................................................

TANCET entrance test

Reg. No. . . . . . . . . . . . . . . . . . . . . . . . . Score : . . . . . . . . . . . . .

GATE Score (if any)

. . . . . . . . . . . . . . . . . .Year : . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Category

...................................................

Remarks

...................................................

Checked by

...................................................

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Name (in Block letters with initials)

Gender ( 9 )

 Male
 Single

Marital status ( 9 )

 Female
 Married

Father/Guardians Name & Occupation

Age & Date of Birth

Age

Date of Birth :

Caste*/Community/Religion/Nationality

Caste

Community :

*copy of permanent community certificate card must be

enclosed

Religion:

Nationality :

Monthly Income of the Father/Guardian/

Other family members

Address (In capital letters)

Permanent

For Communication

Phone with STD code :

Phone with STD code :

Mobile :

Mobile :

e-mail:

e-mail:

Place of Birth* ___________________

Town

___________________
District

___________________
State

* Please enclose Xerox copy of certificate.

Mother Tongue
Details of Health :
a. Height
b. Weight
c. Blood Group
d. General health Condition
e. Have you undergone any major
operation/major health disorder.
If so, give details

.............................................

:
:
:
:
:

.............................................
.............................................
.............................................
.............................................
.............................................
.............................................

Educational Details :
a. School / Polytechnic :
Examination
Passed

Year of
Passing

Name of the Institution and place

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Percentage of
Marks

Remarks (if any)

College
i. Qualifying degree

................................................

ii. Branch

................................................

iii. College & University

...............................................

iv. Give the particulars of marks in each semester after branching off, in the following table.
Sl.No.

Semester

1.

II

2.

III

3.

IV

4.

5.

VI

6.

VII

7.

VIII

Total Marks out of

CGPA

% of marks

Remarks

Grand Total
Average Percentage
v. Class obtained

................................................

Tamil Nadu Common

Entrance Test (TANCET)

Register No. : . . . . . . . . . . . . . . . . . . .Score. . . . . . . . . . . . .

GATE Score (if any, copy to be enclosed): . . . . . . . . . . . . . . . . . . . . . . . . . . . Year : . . . . . . . . . . . . . . .

Academic Honours, Prizes etc.
(Attach extra sheet if necessary)

................................................
................................................
................................................

Professional Details :
Sl.No.

Particulars

Details

i. Teaching Experience
a. Name of the Institution and
the post held

b. Years of service

c. Subjects taught

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Sl.No.

Particulars

Details

ii. Industrial Experience

a. Name of Organisations

b. Nature of work done

c. Years of service
Extra-curricular activities

................................................
................................................
................................................
................................................

Areas of special interest

................................................

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
sons / daughters / wards admission to M.E. / M.Tech degree course can be automatically cancelled
without any reference to me.
Ragging is an offence and I will not involve myself into ragging. I know the punishment for
ragging.
Date :

Signature of the Parent

Signature of the Applicant

FORWARDING NOTE BY EMPLOYER FOR SPONSORED CANDIDATES

This is to certify that Mr. / Mrs. / Miss. ................................................................................ is a
bonofide employee of ...................................................................................................... (Organisation /
Institution), working for the past ................ years. He / She is sponsored to undergo the M.E.
programme (Full time / Part time) for 4 / 6 semesters.
Note : Eligibility for sponsored category : Minimum 2 years full time work experience.
Date :
Place :
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Signature of Employer
with seal
4