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Programme

  1. This form should be filled in by the candidate in (his/her) own handwriting.
  2. The last date for receipt of applications is as announced by the Director, Navyug Vidyapeeth Trust/University of Mumbai/Director of Technical Education, Maharashtra
  3. Incomplete applications and those without necessary attested copies of certificates will not be considered. This attestation has to be from Director, Navyug Vidyapeeth Trust.
  4. A candidate who furnishes false information or suppresses material information will be dismissed and his/her fees will be forfeited
  5. The candidate will have to produce the original certificates and statements of marks at the time of scrutiny of candidature when called for this purpose.
  6. Those candidates who have passed qualifying degree from other than University of Mumbai should furnish Migration Certificate within one month after seeking the admission.
  7. Student must furnish transfer certificate (T.C) from Institute/College last attended at the time of admission.
  8. The admission if granted will be purely provisional and is subject to the total compliance with the eligibility criteria and the submission of all the certificates/documents and is also subject to confirmation by the University of Mumbai.
  9. Reserve category candidates (From Maharashtra only) should submit required documents & must submit at the time of admission only.

(APPLICATION FORM)
TO BE FILLED IN BY THE OFFICE.

1. Application for : .................................................
2. Application No. : .................................................
3. Received on : .................................................
4. Seat No. Of qualifying Entrance test : .................................................

CERTIFICATES (To be attached)

Attested copies should be attached in the following order:
Please state clearly whether attached or not (Attestation has to be from Director, NVT and for that original certificate will be necessary)

Sr. No. DETAILS (SAY YES) (SAY NO)
1. Birth date (S.S.C Certificate) .................. ........... ...........
2. Certificate of Physical fitness from Registered Medical Practitioner. ........... ...........
3. SSC certificate /Statement of Marks .................. ........... ...........
4. HSC certificates/ Statement of marks and other certificates please specify .................. ........... ...........
5. Representation in sports /games /competition .................. ........... ...........
6. Representation in cultural activities .................. ........... ...........
7. Documentation for Reserve Category ..................
  1. Specify category (i.e. whether) .....................
    SC/ST/DTNT/OBC/NT1/NT2/NT3)
  2. Creamy layer certificate .....................
  3. Caste Validity certificate .....................
...........

...........

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

...........

...........
...........
8. Transfer Certificate from the last College attended .................. ........... ...........
9. Migration Certificate from last University attended ..................
(Other than Mumbai University)
........... ...........
10. Gap certificate .................. ........... ...........
11. Father’s / Mother’s domicile .................. ........... ...........
12. Employer’s Certificate .................. ........... ...........
13. Qualifying in Competitive Test .................. ........... ...........
14. Income certificate .................. ........... ...........
15. Any other (Please specify) ........... ...........
TOTAL NUMBER OF CERTIFICATES ATTACHED .............. ........... ...........

I hereby declare that the information given above is true to the best of my knowledge and belief and that the certificates, which are not furnished by me, are not relevant to my application.

Date     : ………………………. 

Place    : ……………………….                                           Signature of the Candidate.

Note: The candidates whose results are yet to be declared should produce statement of marks immediately on declaration of his/her results latest by 30th September. Unless this is done the student will not be eligible under the University Rules. As such his/her admission will be cancelled. Therefore please ensure to submit statement of marks before the last date specified.


Affix latest
Passport size
photograph

Form of application for admission to: ..................................................................

  1. Full Name of the Candidate : Mr./Ms. .........................................................

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

    (In block capitals beginning with surname)

  2. Address for Correspondence : ..................................................................

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

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

    Pin: .......................................... PH: ..........................................

  3. Permanent Address : ..............................................................................

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

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

    Pin: .......................................... PH: ..........................................

  4. Date of Birth (in figures) : .......................................................................

    Date of Birth (in words) : ........................................................................

  5. Birth Place : ..................... Village : ..................... Taluka : ......................

    District : .......................... State : ...................... Nationality : ................

  6. (a) Name of Father or Guardian : ..............................................................

    (b) Relationship of Guardian with the Candidate : .........................................

  7. Present Address & Telephone No. of the Father or Guardian : .........................

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

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

  8. Permanent Address & Telephone No. of the Father or Guardian : .....................

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

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

  9. Father’s /Guardians annual income form all sources (per year) : ......................

  10. Is your father a state/central Government Employee? ...................................

    In case of later give the date when he was posted in Maharashtra: .................

  11. Do you belong to :

    1. Scheduled Castes or Scheduled Caste converted Nav. Buddhas? ............

    2. Scheduled Tribes including those outside specified areas .......................

    3. Denotified Tribes and Nomadic Tribes? ...............................................

    4. Other backward classes? ................................................................

    5. Other than (i) to (v) above : ...........................................................

      (State the caste supported by a copy of certificate)

  12. Do you belong to the Economically Backward class? .....................................

  13. Whether you are a holder of Government of India Backward Class Scholarship during the last year....Yes/No

  14. Extra Curricular Activities:

    1. Participation in Debating /Any other : ................................................

    2. University / State level : .................................................................

    3. Participation in cultural activities (drama /music etc) ............................

    4. Gold Medals/ Trophies obtained for distinguished performance : ..............

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

    5. Any other : ..................................................................................

      (Enclose attested copies in support of your claims as above)


  1. Educational Data

    1. Educational Qualification .................................................................

    2. School last attended ......................................................................

    3. College last attended .....................................................................

    4. Academic achievements (mention awards if any) .................................

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

    5. ..................................................................................................

    6. Extra curricular accomplishments (mention awards if any) .....................

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

    7. ..................................................................................................

  2. Personal Data

    1. Hobbies and Interests : ..................................................................

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

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

    2. Immediate future plans : ................................................................

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

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

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

    3. Work experience if any ...................................................................

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

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

  3. Medical problems, if any : ....................................................................

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

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

  4. Any other relevant information ............................................................

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

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


DECLARATION TO BE SIGNED BY THE CANDIDATE 

  1. I have read all the rules of Admission and I have consulted my parents/guardian and after understanding these rules, I have filled in an application for admission to the ...................... programme at Navyug Vidyapeeth Trust Mahad Distt. Raigad.
  2. The information given by me in the application is true to the best of my knowledge and belief.
  3. I have not been debarred from appearing at any examination held by any Government Constituted or Statutory authority in India or abroad.
  4. I fully understand that admission once granted in particular category, will be final & I will not be entitled t have admission in any other category. Depending on my interest, merit and availability of a seat, my admission is subject to verification of my original testimonials for obtaining the eligibility.
  5. I understand that no other document, other than those attached to the application form will be entertained for the purpose of claims/concessions/weight ages etc. if any in connection with my admission.
  6. I hereby agree to abide by all Rules, Acts and Laws in force by Government /University /Institute /Society and here by undertake that so long as I am a student of the Institute I will do nothing either inside or outside the Institute which may result in disciplinary action against me under the Rules, Acts and Laws.
  7. I fully understand that the Director of the Institute where I would be admitted, will have full liberty to expel me from the Institute for my infringement of the rules of conduct and discipline, attendance and the information given above.
  8. I understand to observe full attendance as per the University/Institute Rules and failing which I am aware that my terms will not be granted.

Place :                                                                      (Signature of Candidate) 

Date :                                                                        Name: 


CERTIFICATE OF PHYSICAL FITNESS
(By a Registered Medical Practitioner) 

I certify that I have carefully examined Mr. /Ms.  ………………………………………………and further certify that his/her eyesight is good and any minor defects therein can be over come by means of suitable glasses; that his/her constitution is sound; and that he/she has no disease bodily or mental infirmity unfitting him/her now or likely to unfit him/her in future from work in the Institute or active outdoor service as a ………………… student. 

 

Date :                                                                     Signature : 

Address:                                                                  Name: 

Qualification:                                                            Registration No: 

NOTE: In case of the foreign students they should undergo tests for Aids at the recognized medical Institute and produce the certificate from any Civil Surgeon or Dean Medical College to that effect.


DECLARATION TO BE SIGNED BY CANDIDATE BELONGING TO BACKWARD CLASS

I understand that admission given to me against quota for the reserve category is provisional and will be cancelled if my caste claim is rejected by the Director Social Welfare Maharashtra State, Pune & if I have not submitted all required document in support of my claim. 

 

Place :                                                                          (Signature of Candidate) 

Date :                                                                            Name: 


CERTIFICATE FROM EMPLOYER

This is to certify that Mr./Ms.  ……………………………………………………….  is working with this organization as  ……………………………  This organization has no objection to allow him /her to attend the ……………………………………………………… Programme in Navyug Vidyapeeth Trust Mahad if he/she is admitted for the same and further certify that he /she will be relieved for attending classes/lectures seminars/symposia /practical training etc. as per the training notified by the Institute. 

 

Date:                                                                               Signature of Employer 

Place:                                                                              Designation:


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