Application Form
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Fields marked with*are mandatory.
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Personal Information
*Name of the applicant (As in Qualifying Examination)
(First Name) (Middle Name) (Last Name)
*Date of Birth
*Gender Male Female
*Mother's Name *Category
*Father's Name *State of Domicile
*Guardian Name *Guardian Relationship with the Applicant
*Mobile No. *Email Address
Telephone with Area Code *Confirm Email

Present Address
*Address Line 1
*Country
Address Line 2 *State
*Town/City *District
*Pincode

Permanent Address Same as Present Address? Yes No

Permanent Address
*Address Line 1
*Country
Address Line 2 *State
*Town/City *District
*Pincode



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Courses
*Type
Please select course category option
Diploma   Under Graduate  Post Graduate 


Accommodation and transport requirement detail
Note Subject to availability.
*Do you need hostel accommodation?
Yes  No 
*Do you need transport? Yes  No 
   
Qualifying Examination Details
Name of the
Exam.
Name of Board /
University
Year of Passing School / Institute
Name & Add.
Whether Govt./
Pvt. Institute
Marks / CGPA Obtained Maximum Marks / CGPA Percentage of Marks
10th
12th
Diploma
UG
PG
  
* Are the result and details of the qualifying exam available now?
    Yes    No   

  *Qualifying Examination     *Roll Number
  *Total Marks Obtained   
  *Total Percentage
  *Board/University
  *Year Of Passing (YYYY)
 
Note Please note that all relevant information and details if applicable to you should be sent to PDM as and when they are available, but before the last date of application.
   
*Payment Procedure
Note Applicants are required to remit Rs 1000 as application fee. The amount can be remitted to us by following three modes.
Cash payment at PDM
Cash Payment through Scratch Card
Online Payment (Credit Card / Debit Card)
Application enclosures
Note Please enclose the following documents in original alongwith this form printout at the time of physical counselling.
    1. Rank Card of the relevant Entrance Test(s) as claimed in the application form.
    2. Matriculation / High School Certificate (for Date of Birth)
*3. Qualifying Examination i.e. 10+2 / Diploma / Graduation / Post Graduation or any other examination (for eligibility)
    4. Character Certificate from the Institution last attended (for regular students).
*5. Migration Certificate
*6. Address Proof (Ration Card / Electricity Bill / Telephone Bill, etc.)
    7. SC/BC Certificate ( if Applicable)
*8. 6 Passport size recent colored photos.
    9. Certificate of Medical Fitness in the prescribed Performa.
*10. Affidavits in Prescribed format regarding non indulgence in ragging.
Declaration

 

I declare the information provided by me is true in all respect and in case any information found to be false, my admission would stand cancelled automatically.
I am aware that taking part in Ragging is a criminal offence and a person indulge in any such activity is liable to be prosecuted under law of the land. I understand not to participate in any act of RAGGING and in case of violation of any of the rules, I will be liable to strict disciplinary action, which will even lead to my expulsion from the College.
I will abide by the Ordinance / Regulations / Rules of the College, which are in force at the time of my admission or which may be subsequently made applicable during my course of study.
I will maintain at least 75% attendance in each semester as per the rules and regulations of the University, failing which I may be debarred from appearing in the term and examination and punished as per rules / regulations etc.
In case, I am found involved in any act of misconduct or moral turpitude in and / or outside the College premises or any act of damage to the College property / equipment, for which a complaint is lodged with the College authorities or with the police authorities, I will be liable to any disciplinary action as decided by the College Authorities. I will pay the fees as applicable from time to time, regularly by the stipulated date.

......................................
Signature of the Candidate

UNDERTAKING OF PARENT / GUARDIAN
I, _______________________ Father / Mother / Guardian of Mr. / Ms. _________________________ who has sought admission in the College in 1st year, do hereby undertake that shall ascertain at my own level from the College Authorities during the academic session about the attendance of my son / daughter / ward and whether he / she is meeting the attendance requirement as per current provisions in the relevant ordinance of the affiliating University.
I have read the declaration made by my son / daughter / ward as above and endorse the same. I understand to keep myself abreast of the progress of my son / daughter / ward including his / her attendance in the class.
I certified that the information has been verified from the Original documents and eligibility of the candidate has been ascertained as per provisions of the affiliating University / State Govt.

......................................
Countersigned by Parent / Guardian

 
          I Agree  

   
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