College of Engineering and Technology, Bambhori, Jalgaon Welcomes you !!!

To be filled up by Student

1) Name:


Surname	First Name	Middle Name	Father's Name

2) Correspondence Address:

City/Town/Village: District:
State: Taluka:
Pin Code: (Optional)

3) E-mail Address:

(Optional)(required for faster communication)

4) Telephone Numbers (With STD Code):
(required for faster communication)

Resi:
Off:
Mobile:

5) Select your First Year Degree Course Admission preference:

1)
(-- Select your additional Priority --)
2) 3)
4) 5)
6) 7)

6) Select Your Admission Category:

7) Date of Birth (DD/MM/YYYY)

8) Gender: Male Female

9) Occupation of the Earning member(s) of the family

10) Annual Income of Family: (Indian Rs.)

11) CET Type attended:

12) CET Information:

Exam Seat No: Score obtained: Rank/ Merit No:

12) Details of Qualifying Examination (Std. XII) passed
Month & Year of Passing	Name & Adddress of Institution	Name & Address of Board/ University	Passed from Maharashtra? Yes/ No
			Yes No

Subject	Marks Obtained			Other Information	Remarks/ Result
Subject	Outof	Theory	Practical	Other Information	Remarks/ Result
1) Physics				Total Marks obtained:
2) Chemistry				Out of Total Marks:
3) Maths				PCM:
4) Biology				PCB:

13) Details of SSC (Std. X) Examination Passed:
1) Maths:		Out of:
2) Science:		Out of:
3) SSC Aggregate:		Out of:
Total Marks obtained:		Out of Total Marks:
Year:		Month:

Place:

Please do not make multiple Submission. Only One Application form per person will be accepted. Please review your form carefully before submitting. You may also keep a Printed Copy of this Form by Clicking here.This form is being treated as your intent for admission.
By submitting this form you also agree that you will submit the necessary required documents to prove the authenticity of data submitted hereinabove.