RPS Group of Institutions: (Engineering & Management)

RPS Group of Institutions Application No…..
(Engineering & Management)

(Approved by AICTE, New Delhi & Affiliated to M.D. University Rohtak)
Satnali Road, Balana, Mohindergarh – 123029 (Haryana)
Phone: 01285-241431, Fax : 01285-241434
E-mail: [email protected] Website: www.rpsinstitutions.org Affix Your
Admission form Recent Colored

Photograph here
Session: 20 -20 Semester: I III
(LEET)
B.Tech Programme (√ Mark in the box) Management Programme (√ Mark in the box)
CSE Civil ECE ME MBA BBA BCA

EE
M.Tech Program me (√ Mark in the box) Diploma Programme (√ Mark in the box)
CSE ME ECE ME Civil
1. Name of the Candidate:
2. Father’s Name:
3. Mother’s Name:
4. Correspondence Address:
District State
Country PIN
5. Permanent Address:
District State
Country PIN
6. In case of any emergency, please indicate your local guardian’s particular, if any
Guardian’s Name
Telephone No. Mobile No.
Email Id:
7. Phone no. with STD code (Essential): Mobile No.
E-mail Id:
8. Date of Birth: Day Month Year

9. Nationality: Indian NRI Foreigner, Country……………………………………….
10. Religion:…………… 11. Which category you belong to General SC ST OBC
12. Whether you are a Kashmiri Migrant: Yes No
13. Accommodation: Hostel required Own arrangement If Hostel A/C Non A/C
Accommodation Room Room
14. Transport: From………………………………………… To …………………………………………………………………………….
15. Application Fee details (In case of download form):
DD No. ……………………………… Bank …………………………………………… Amount ……………………Date………………
Programme Applied for: 1st Year Admission LEET Admission
a. B.Tech. Computer Science & Engg. (CSE)

b. B.Tech. Electronics & Communication Engg. (ECE)
c. B.Tech. Mechanical Engg. (ME)
d. B.Tech. Civil Engg. (CE)
e. B.Tech Electrical Engg.(EE)
f. M.Tech. Computer Science & Engg. (CSE)
g. M.Tech Mechnical Engg.(ME)
h. M.Tech Electronics & Communication
i. MBA
j. BBA
k. BCA
l. Diploma Mechanical Engg. (ME)
m. Diploma Civil Engg. (CE)
Academic Record
Exam Passed Year Board/University School/College/Institution Division Percentage
Name / CGPA in PCM**
X
XII
B.A./B.Sc/B.Com*
B.E./B.Tech*
*Required in case of MBA, M.Tech Only.
** In place of chemistry optional of computer science or biology or bio technology is allowed.
Admission test Details: (Tick the appropriate items):
AIEEE/LEET/MAT/CAT/GATE Roll no…………………………AIEEE/LEET/MAT/CAT/GATE Rank……………….

Undertakings for Admissions:
In case I am admitted: I undertake that I will make all the payments as laid down by the
concerned institute from time to time. I solemnly declare that the information provided by me in
the admission form is correct and I have not concealed facts. I undertake to abide by all the rules
and instructions of the University and the institute. I am taking admissions in the institute
provisionally at my own risk and responsibility subject to the confirmation of my eligibility by the
university. If at any stage I am declared ineligible and my admission is cancelled by the University
as per rules, I will have no claim for it. Further, I undertake not to take part in Ragging, Act of
Indiscipline or any unlawful activities whatsoever directly or indirectly.
……………………………………………………….. ………………………………………………
Sign. of Parents/Guardian Sign of Candidate
Date………………………………………… Date…………………………………………
Enclosures: 1. Copy of Certificate of X & XII Standard 2. Original Diploma/Degree/Provisional
Certificate showing detailed marks. 3. Copy of Mark sheet of B.A./B.Sc./B.Com./B.Tech 4. Copy of
Certificate of SC/ST/OBC, if any 5. Copy of AIEEE/LEET/MAT/CAT/GATE entrance test & result card.
6. Character Certificate 7. Medical & Fitness certificate 8. 04 passport size photograph (Color). 9.
Migration certificate

RPS Group of Institutions: (Engineering & Management)

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RPS Group of Institutions Application No…..

(Engineering & Management)

Admission form Recent Colored

CSE Civil ECE ME MBA BBA BCA

Telephone No. Mobile No.

7. Phone no. with STD code (Essential): Mobile No.

8. Date of Birth: Day Month Year

a. B.Tech. Computer Science & Engg. (CSE)

AIEEE/LEET/MAT/CAT/GATE Roll no…………………………AIEEE/LEET/MAT/CAT/GATE Rank……………….

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