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    TYCS_from

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    modeldeepak122
    The document is an application form for admission to the B.Sc. (Computer Science) program at Dombivlis Model College under the University of Mumbai for the academic year 2024-2025. It includes personal information about the candidate, educational details, and a declaration regarding the accuracy of the information provided. The candidate, Deepak Ramdayal Chaurasiya, is from Maharashtra and has completed his 10th and 12th grade education under the Maharashtra State Board of Secondary and Higher Secondary Education.

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    The document is an application form for admission to the B.Sc. (Computer Science) program at Dombivlis Model College under the University of Mumbai for the academic year 2024-2025. It includes personal information about the candidate, educational details, and a declaration regarding the accuracy of the information provided. The candidate, Deepak Ramdayal Chaurasiya, is from Maharashtra and has completed his 10th and 12th grade education under the Maharashtra State Board of Secondary and Higher Secondary Education.

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    The document is an application form for admission to the B.Sc. (Computer Science) program at Dombivlis Model College under the University of Mumbai for the academic year 2024-2025. It includes personal information about the candidate, educational details, and a declaration regarding the accuracy of the information provided. The candidate, Deepak Ramdayal Chaurasiya, is from Maharashtra and has completed his 10th and 12th grade education under the Maharashtra State Board of Secondary and Higher Secondary Education.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    4 views2 pages

    TYCS_from

    Uploaded by

    modeldeepak122
    The document is an application form for admission to the B.Sc. (Computer Science) program at Dombivlis Model College under the University of Mumbai for the academic year 2024-2025. It includes personal information about the candidate, educational details, and a declaration regarding the accuracy of the information provided. The candidate, Deepak Ramdayal Chaurasiya, is from Maharashtra and has completed his 10th and 12th grade education under the Maharashtra State Board of Secondary and Higher Secondary Education.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    You are on page 1of 2

    7/18/24, 7:51 PM about:blank

    For Office Use


    Batch: Scrutiny Payment: Online/DD PI

    Only Serial:

    Keraleeya Samajam (REGD.) Dombivlis Model College (102)


    Application No :
    University of Mumbai 50390
    M.G.Road, Fort, Mumbai-400032, Maharashtra(India)
    Academic Year: 2024-2025
    Regular
    APPLICATION FORM

    Course Applied for : B.Sc. (Computer Science) (Autonomous)(with Credits) - PRN:2022016401059566


    Regular - CBCS - T.Y.B.Sc. (Computer Science) (Autonomous) Sem V (-)

    Application Date : 18/07/2024 Payment Category : 13


    1.Personal Information

    Candidate's Name(Regional) :
    Candidate's Name as printed on CHAURASIYA DEEPAK RAMDAYAL
    Mark sheet : [*This name will appear on all University records/documents]
    Father's/Husband's Name : RAMDAYAL Mother's Name : KALAWATI
    Marital Status : UnMarried Mother Tongue :
    Place Of Birth : Mahani Gender : Male Date of Birth (DD/MM/YYYY) : 11/06/2003
    Blood Group : Religion : Country of Citizenship : India
    Is Student NRI/ Foreign National : No Domicile State: Maharashtra
    Address For Correspondence :
    Location Area : Not
    State : Maharashtra District : Thane Tehsil : Kalyan City/Town/Village :
    Available
    Address (House CHAWL NO:4 ROOM NO:6 SHREE COLONY Piswali GAO TATA POWER HOUSE
    Pin Code : 421306
    no,street/area/suburb etc.) : KALYAN EAST
    Contact details
    Mobile Number 919321834852 Email ID: chaurasiyad147@gmail.com
    2.Legal Reservation Information
    Category Type : Open Category : GEN
    Is Guardian from EBC (Economic Backward
    Is Specially Abled? No
    Class)? No
    3.Social Information(Additional Inforamtion)
    Not Applicable
    Paper Selected for:
    Sem V
    BSCCS001 - PAPER I BSCCS002 - PAPER II
    BSCCS003 - PAPER III BSCCS004 - PAPER IV
    Sem VI

    BSCCS005 - PAPER V BSCCS006 - PAPER VI


    BSCCS007 - PAPER VII BSCCS008 - Paper VIII

    Medium of Instruction : English


    4.Guardian Information
    Occupation of Guardian : Service Annual Income of Guardian : 15000
    5.Educational Details
    Month and Exam
    Name of Name of Board/University and State Name of Certificate Mark
    Year of Seat Out of CGPA %
    Examination of University School/College No. Obtained
    Passing No.
    MAHARASHTRA STATE BOARD OF
    Std 10th SECONDARY AND HIGHER March 2020 -- -- 328.00 500.00 -- - -- 65.60
    SECONDARY EDUCATION,
    MAHARASHTRA STATE BOARD OF
    Std 12th 12Th
    SECONDARY AND HIGHER March 2022 -- -- 275.00 600.00 -- - -- 45.83
    (Science)
    SECONDARY EDUCATION,
    Your Last Qualifying Exam:
    7.Other Information

    about:blank 1/2
    7/18/24, 7:51 PM about:blank

    Would you like to apply for Hostel accommodation required NA


    DECLARATION
    I hereby declare that all the information furnished by me in this application form is true, complete and correct to the best of my knowledge and belief. I do
    understand that I need to obtain and produce all the required documents. I admit to having understood what constitutes ragging and sexual harassment. I
    have read the guidelines related to the same. I hereby affirm that if found guilty of ragging or sexual harassment I am liable for punishment according to
    the university regulations.

    Place : Date :
    ( Signature of the Candidate )
    Document printed on Thu Jul 18 2024 19:50:54 GMT+0530 (India Standard Time)

    about:blank 2/2

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