Online Registration

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REGISTRATION FORM FOR B.Tech COURSE-SESSION 2016-2017
Every mandatory field is marked with * STAR or written (required). These fields must be completed accurately for your application to be considered.It is required to enter the Mobile Number and Email Address, which can be used for Communication from V.I.M.T.
Once you have completed the form, you should submit your application by clicking the "Submit" button.For further process, refer Admission Policy.

Upload Your Photo (not more than 20 kb) (required) Upload Your Signature(not more than 20 kb) (required)

Branch Applied For

First Preference (required) Second Preference (required) Third Preference (required)

Personal Details

1.Name of Candidate (required) 2.Father's Name (required) 3.Mother's Name (required)
4.Date of Birth (required) 5.Gender (required) 6.Category

Communication Details

7.Correspondence Address

8.Father's Mobile No. (required) 9.Student's Mobile No. (required) 10. Email (required)

11.Domicile (required)

If, Other State Please Mention the Name of State

Academic Details

12.Academic Qualification

Name of Examination Board/Univerity Medium Name of School/College Roll No. Year of Passing Percentage/CGPA
10th/SLC HindiEnglish
12th/Inter HindiEnglish
Graduation/Diploma HindiEnglish

13.Details of Marks Secured with %age in PCM

Subject Maximum Marks Marks Obtained Percentage/CGPA
Physics
Mathematics
Chemistry/Biology/Bio-Technology/Technical Vocational Subject

14. If you are appeared in Entrance Test, Please Furnish details

Name of Entrance Examination Roll No. Month & Year Score/Rank
UPSEE-2016
JEE(Main)
VMAT-2016

If, Appeared in Other State Entrance Examination, Please Specify

Facilities

15.Whether Hostel Accommodation is Required ? YesNo 16.Whether Bus Facility is Required ? YesNo 17.If Yes, Please Specify the Pickup point/Stoppage

Refernces

Serial No Name & Designation Mobile No. Relationship, If Any
1.
2.

Undertaking by Student/Parents

I, S/o

hereby declare that the information furnished above is correct and complete. I admit that incorrect information or concealment of facts, may disqualify me for admission. I agree to abide by the rules and regulation of the institute further, i hereby undertake that:-
a) I will always maintain at least 75% attendance, failing which I may debarred from appearing in Session/University Examination.
b) I will not indulge myself in any activity of ragging my fellow students or damage of property or act of indiscipline etc. I know that ragging is criminal offence under the provision of Law.
c) I shall register myself in every session after paying all dues on prescribed dates as announced by the Dean/Director of the Institute.
d) I shall not claim for any refund of fee deposited on completion of formalities of admission.