2164369 St Peter Engg College Application Form

Regd. No. Application No. St. Peter’s Engineering College, (Approved by the AICTE, New Delhi and Affiliated to the Anna University, Chennai NBA Accredited and ISO Certified Institution ) AVADI, CHENNAI – 600 054. APPLICATION FORM FOR ADMISSION TO THE B.E. / B.Tech. / M.E. /M.B.A./M.Sc. (2Yrs) / M.Sc. (5Yrs) / M.E. Degree Course 2006 - 07 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. B.E. Computer Science and Engineering B.E. Electronics and Communication Engineering B.E. Electrical and Electronics Engineering B.E. Electronics and Instrumentation Engineering B.E. Mechanical Engineering B.E. Production Engineering B.E. Civil Engineering B.E. Bio – Medical Engineering B.Tech. Information Technology B.Tech. Chemical Engineering B.Tech. Bio – Technology M.E. CAD / CAM M.E. Power Electronics and Drives M.E. Applied Electronics M.E. Engineering Design M.E. Instrumentation Engineering Master of Business Administration Master of Computer Applications Name of the Applicant (In BLOCK letters) : ………………………………………………………………… Address for Communication (In BLOCK Letters) ______________________________________________ ______________________________________________ ______________________________________________ Pin :______________ Phone ______________________ (with STD Code) 1

INSTRUCTIONS 1. Read all the instruction carefully before filling up the application form. 2. No original certificate should be attached with the application. 3. Only Xerox copy of the mark sheet of the qualifying exam must be enclosed. 4. Applicants who have passed examination other than CBSE / ISC / DBSCE or State Board Examinations of Tamilnadu should obtain eligibility certificate from the Anna University in support of their eligibility to join B.E./ B.Tech Degree Course of the University. 5. The candidate should ensure that the correct marks are furnished by him / her in the application form. The candidate is informed that if after the proper scrutiny of his / her marks, it is found that the marks furnished by him / her in the application form are not correct then, (i) (ii) (iii) he / she well forfeit that admission no matter at what stage of the course he / she is at that time. he / she will be debarred from pursuing any course of study for a period of three years. Legal action will be instituted against him / her for furnishing wrong marks. 2

1. Name (IN BLOCK letters) 2. 3. 4. Sex Date of Birth (DD/MM/YY) Place of Birth : : Male : Female District : : Village : : Yes : : Hindu Christian : OC MBC / DNC 5. Are you a citizen of India? 6. Mother Tongue 7. A. Religion (Tick in the Box applicable ) B. Community (Tick in the Box Applicable) No Muslim Others BC SC / ST Particulars of BC / DNC / MBC / SC / ST certificate i. Name of the caste ii. Sl. No. of the certificate iii. Date of issue : : : iv. Designation of the issuing officer : v. Office of issue : : : : : Office Address : ___________________________________ __________________________________ ___________________________________ Pin : _____________ Phone ____________ (with STD Coder) 8. Name of Parent / Guardian Occupation Annual Income Residence Address _________________________________ _________________________________ _________________________________ Pin : _____________ Phone __________ (with STD Coder) 3

9. Choice of Course (Please indicate your order of preference of courses using numerals 1,2,3, etc. in the boxes provided: Sl. No. COURSE ORDER OF YOUR PREFERECES 1. 2. 3. B.E. Computer Science and Engineering B.E. Electronics and Communication Engineering B.E. Electrical and Electronics Engineering B.E. Electronics and Instrumentation Engineering B.E. Mechanical Engineering B.E. Production Engineering B.E. Civil Engineering B.E. Bio – Medical Engineering B.Tech. Information Technology B.Tech. Chemical Engineering B.Tech Bio – Technology M.E. CAD / CAM M.E. Power Electronics and Drives M.E. Applied Electronics M.E. Engineering Design M.E. Instrumentation Engineering Master of Business Administration Master of Computer Applications Master of Science (Information Technology – 2 years) Master of Science (Computer Technology – 5 years) 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. v 17. 18. 19. 20. 10. Extra Curricular activities : (Originals must be produced at the time of admission) a) Sports : . . ………………………………………………………………………. b) Games : ………………………………………………………………………… c) N.C.C. : ………………………………………………………………………… d) Others : …………………………………………………………………………... 11. ADMISSION TO B.E. / B.TECH. i. Academic Stream : Reg. No. …………………………………. Board ………………………………… No. of attempts : …… ……………………. Year ………………………………….. Institution : ………………………………………………………………………….. SUBJECT MARKS OBTAINED MAXIMUM MARKS PERCENTAGE Higher Secondary Marks {M+(P+C)/2} : / 200 4

Higher Secondary Average Marks of (M+P+C) ii. Vocational Stream : Reg. No. ………………… ………………. : / 100 No. of attempts : …………………………. Year ………………………………….. Examination Board : …………………………… …………………………………… Institution : ………………………………………………………………………….. SUBJECT MATHS / PHYSICS / CHEMISTRY VOCATIONAL SUBJECTS PUT TOGETHER HSC Vocational Marks : (Marks in M or P or C, Plus marks in vocational subjects put together) = ………/ 200 MARKS OBTAINED MAXIMUM MARKS PERCENTAGE iii. Entrance Examination DETAILS Register Number Marks Obtained in Mathematics Marks obtained in Physical Science To Marks obtained : TNPCEE CET iv. (i) Total HSC + Entrance marks in TNPCEE (ii) Total HSC + Entrance marks in CET Overall rank in CET : : : / 300 / 300 Overall rank in Anna University Rank List : 12. FOR SECOND YEAR LATERAL ADMISSION : Name of the Diploma Passed Registration Number DIPLOMA EXAMINATION PRE-FINAL SEMESTER SUBJECT % of Marks Obtained 1. 2. 3. 4. 5. 6. Total 1. 2. 3. 4. 5. 6. Total FINAL SEMESTER SUBJECT % of Marks Obtained : : Year of passing : Total Marks (Pre-Final & Final semester) : …………………….. / 100 DIPLOMA (SANDWICH) EXAMINATION FIFTH SEMESTER SUBJECT % of Marks SIXTH SEMESTER SUBJECT % of Marks SEVENTH SEMESTER SUBJECT % of Marks 5

Obtained 1. 2. 3. 4. 5. 6. Total 1. 2. 3. 4. 5. 6. Total Obtained 1. 2. 3. 4. 5. 6. Total Obtained Total Marks (V, VI & VII Semester) : …………………….. / 100 13. ADMISSION FOR M.Sc. (CT) (i) Higher Secondary Marks S.No. 1. 2. 3. 4. 5. 6. 7. Subject Language – I Language – II ………………. ………………. ………………. ………………. ………………. Total : : : % % ----------------------Total 14. FOR M.E. ADMISSION Name of the Degree Obtained Name of the College Name of the University Register No. : …………………………… : : : Year of Passing : ………………………….. % -----------------------% of Marks (ii) Diploma Marks : Pre – Final Final Marks obtained (3rd to 8th Semester ) : ……………………… % ENTRANCE EXAM TANCET CET OTHERS, Specify REG. NO MARKS RANK 15. FOR MBA / MCA / M.Sc. (IT) ADMISSION Name of the Degree Obtained : 6

Name of the University Name of the College Register No. : …………………………….. Whether Mathematics is one of the subjects in +2 or degree level (for MCA, proof to be enclosed) No. of Attempts Division / Class ENTRANCE EXAM. TANCET CET OTHERS, Specify Part – I …………… REG. NO. : : Year of passing ………………… : : Yes / Not Applicable Part – II …………… MARKS OBTAINED MAXIMUM Part – III …………… RANK DECLARATIONS BY THE APPLICANT, PARENT / GUARDIAN I ………………………………………………………. S/O. D/O. ……………………………………… …. hereby solemnly and sincerely affirm that the statement made and the information furnished by me in the application as also in the enclosures submitted by me are true. If it is proved at any stage that there is incorrect or false statement or data, I hereby agree to be proceeded against legally, eventually leading to my dismissal from the institution and I also agree that I would lose all rights and claims consequently. I am aware that ragging within or outside the Institution is prohibited and it is punishable with imprisonment and liable to a fine and dismissal from the Institution. I affirm, that I will not directly or indirectly commit, participate, abet or propagate ragging within or outside the Institution. Place ………………… Date : …………………. Signature of Candidate : ………………… Name in Block letters …………………… I …………………………………………………… F/o. / M/o. …………………………………………….. do hereby declare that all the information given herein are true and correct. I stand guaranteed for the good conduct of my ward during the course of his / her study. I authorize the institution to initiate disciplinary action against my ward for violation of any of the rules and regulations. I also promise to compensate damage that may have been caused by my ward due to his / her action. 7

I am that ragging within or outside the Institution is prohibited and it is punishable with imprisonment and liable to a fine and dismissal from the Institution. I affirm that my son / daughter will not be direcly or indirectly commiting, participating, abetting or propagating ragging within or and outside the institution. Place ………………….. …. Date …………………… Name in Block letters : …………………… ……………… Signature of the Parent / Guardian : …………………… Completed applications must be sent by post or delivered in person to THE PRINCIPAL St. PETER’S ENGINEERING COLLEGE AVADI, CHENNAI – 600 054, Phone : 044-26558080 to 26558084 Fax : 044-26558080 to 26558084 Extn. : 128 (or) Administrative Office : SIRE MANSION, (Khivraj Motors Building), 621, Anna Salai, Chennai – 600 006. Ph : 044 – 28293218 Telefax : 04428295110 CHECK LIST 1. Photograph Affixed 2. Whether order of preference is filled up. 3. Declaration signed by candidate and parent. 4. Enclosures : a) Attested copies of (i) (ii) (iii) (iv) X and XII examination mark sheets [for B.E. / B.Tech. / M.Sc. (CT)] X and Diploma pre and final semester mark sheets [for Lateral Entry] X and Degree mark sheets [for M.E. / MBA . M.Sc. (IT)] X, XII and Degree mark sheets [for MCA] b) TC SC f)

Attested copy of TNPCEE / CET / TANCET Entrance Marksheets. c) Attested copy of d) Attested copy of the Permanent Community Certificate (for BC / MBC / DNC / / ST candidates only) e) Attested copy of Nativity Certificate (if applicable) Attested copy of certificates of sports, games NCC etc. (if any)

g) Two numbers of self – address covers with postage stamp for Rs. 5/ each. 8