Application form for Admission to Science. Programme

N.B. 1) Fill all the columns carefully. Incomplete form will not be accepted.
2) Wrong / False information, If provided, will lead to cancellation of admission.
App. No 1534387266

Admission sought in year of science during the academic year 2018-2019

1. Name : Mr./Ms ((IN BLOCK LETTERS) (As appeared in HSC Certificate)

surname

name

Fathers name

Mothers name

2. Present Address

3. Native Place Address : (For Long Journey Concession)

Student Contact No

Parent Contact No

4. Date of Birth

Age

5. Place of Birth

6. District

7. State

8. Nationality

9. Caste

10. Religion

11. Mother Tongue

12. Blood Group

13. Adharcard No

14. Student Email ID:

15. Physically Challenged Yes/ No. If Yes, submit documentary proof for the same

16. Do you belong to SC/ST/DT/NT/VJ NT/ OBC/ SBC
Yes/No (If Yes, submit documentary proof for the same for getting freeship/scholarship)

17. Do you belong to Muslim / Sikh / Boudh/ Christian/ Parsi/ Jain/ Maratha Community ?    If yes then choose

18. Subjects offered: (put tick on Selected Subject)

Three Years B. Sc. Programme

Class

Courses Offered

FYBSC (I & II Semester)

1. Core Science  Courses: (Choose three courses  from the following.)

Physics
Chemistry
Mathematics
Botany
Zoology

2. Foundation

SYBSC (III & IV Semisters)

1. Core Science  Courses: any two courses of the three courses opted in FYBSC
 
2.Foundation Course

1. Physics, Chemistry
2. Physics, Maths
3. Chemistry, Botany
4. Chemistry, Zoology

TYBSC (V & Vi semesters)

6-Units: any one of the core courses opted at SY level:

Physics
Chemistry
Mathematics

3-Units: any one of the following Combination Of two core courses as opted at SY level:

Chemistry & Botany
Chemistry & Zoology

6/ 3 Units Applied Component Course

Electronic Instrumentation
Drugs & Dyes
Computer Programming
Environment Science 
Web Designing and Applications

Note: All the above course/s will be offered subject to minimum required number of students as prescribed by the statutory authority.

19. Academic Record (Attach xerox copies of Marksheet)

Examination Passed

Board/University

Month & Year

Pass/ATKT

Class/ Grade Obtained

S.S.C.

H.S.C.

F.Y.B.Sc. Sem I & Sem II

S.Y.B.Sc. Sem III & Sem IV

20. Particulars of Parent/ Guardian

a. Name

b. Relationship will the student (in case of guardian)

c. Occupation

d. Office Address

e. Office Phone No.

f. Adhar Card & or Pan Card No.

g. Total annual income from all sources

h. Total no. of dependents

i. Parent Email ID

j. Mobile No.

DECLARATION BY THE APPLICANT

The Principal,

N.E.S. Ratnam College of Arts, Science & Commerce

Bhandup (West), Mumbai - 400078.

I,

seek admission in

class of your college with the consent of my Parent / Guardian Mr. /Mrs.

a. I undertake to abide by all the rules and regulations of the college, particularly those relating to to conduct and discipline, which are in force at present and which may be enforced in future.

b. I undertake that i will not damage or destroy the college property / mutilate or damage any book issued to me from the college library.

c. I understand that I shall not be granted by any term, if my attendance at lectures, tutorials and practicals fall short ofthe minimum prescribed by the university.

d. I shall not indulge in any kind of activities which will mar the academic atmosphere and prestige of the college.

e. I know smoking is strictly prohibited in the college premises including canteen.

f. I know that use of mobile phone in the college premise is punishable as per University guidelines.

g. I understand that violation of any Discipline Rule's Will result in removal of my name from the college record and I agree to it.

Yours faithfully,

(Applicant's Signature)

Date

DECLARATION BY THE PARENT / GUARDIAN

1. I,

on my part agree to the conditions' rules stated above.

2. I, assure you that my ward Mr. / Ms

    if admitted, will be regular in attendance at Lectures / Tutorials / Practicals/ Tests / Examinations.

3. In case the attendance / Performance of my ward is / are not satisfactory, he / she may not be granted terms

   and he / she may also not be sent for the College / University Exam.

4.  I am aware that violation of any of the Discipline Rule's by my ward will result in his/her removal from the college & I agree to it.

 

(Signature of Parent / Guardian)

Date

 

FOR OFFICE USE ONLY

Document required to be attached

Please Tick the documents received

1.Original Marksheet of H.S.C. and 2 attested xerox copies of the same. (only for F.Y.B.Sc.)

2. Original Leaving Certificate and 2 attested xerox copies of the same. (only for F.Y.B.Sc.)

3. 1 attested xerox copy of S.S.C. Marksheet. (only for F.Y.B.Sc.)

4.Original Marksheets of lower Examinations (F.Y. / T.Y.B.Sc.) for verification (for S.Y. / T.Y.B.Sc)

5. 1 attested xerox copy of marksheet of the lower examinations. (for S.Y. / T.Y.B.Sc)

6. Caste certifacate and 1 attested xerox copy (only for students belonging to SC/ST/DT/NT/VJNT/OBC/SBC)

7. Affidavit (where there is a break in studies)

8. Students passing the qualifying examination from Board / University other than Maharashtra State Board / Mumbai University shall be required to attach the following additional certificates along with above mentioned certificates.

a) Original Migration Certificate and 2 attested xerox copies.

b) Original Transference Certificate and 2 attested xerox copies.

9. NOC / TC in case of students from other Colleges affiliated to University of Mumbai.

REMARKS OF THE ADMISSION COMMITTEE

 

(Signature of Parent / Guardian)

Date