GENBA SOPANRAO MOZE COLLEGE OF ENGINEERING
 SURVEY NO 25/1/3/, BALEWADI, TAL : HAVELI, PUNE - 411045
Telephone : 020 - 27290500
E-mail gsmoze@yahoo.com, Website : www.gsmozecoe.com

APPLICATION FOR ADMISSION TO FIRST YEAR ENGINEERING

    Name of Candidate :

 (in block letters as in mark sheet of qualifying exam)
    Sex : Male Female
    Date of Birth :

    Parent's / Guardian's Name :

 

    Address for Correspondence :

 

    Address for Parent / Guardian : (If Different from above)

 

    Telephone No :

STD Code :  Phone No. :
 Mobile No :

    Email ID :

    SSC Examinations :

Year of Passing Name of the board Grand total of Marks Marks in Mathematics
Marks obtained Out of Marks obtained Out of

    HSC (Qualifying Examinations) :

Year of Passing Name of the board Grand total of Marks Marks in Mathematics Marks in Physics Highest Marks in Chemistry or any other optional
Marks obtained Out of Marks obtained Out of Marks obtained Out of Marks obtained Out of

    Diploma (Those who have done three years diploma with medium English only) :

BranchYear of Passing Name of the board Grand Total of Marks
Marks obtained Out of
    Whether the candidate is:
 From Maharashtra    Out of Maharashtra
    Whether the candidate belongs to Backward class: (Tick appropriate Box)
 Yes                       No

    If Yes indicate categoryand caste :

 
    Chice of Branch : (With order of preference)
 Computer Engineering
 Electronics & Telecommunication Engineering
 Mechanical Engineering