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1. INTERNATIONALCENTRE OF EXCELLENCE IN ENGINEERING
AND MANAGEMENT AURANGABAD (ICEEM) 2516
CEEM
Expanding Horizon
ENGINEERING ADMISSION FORM
Academic Year: _____________________________________
Admission Through: CAP Institute Level
Applying for Discipline F.E. ENGG DSE
Branch: ___________________________________________________
Name of Candidate
(as per SSC Certificate)
Date of Birth Gender Male Female
Religion: __________________________ Caste: ___________________________ Sub-Caste: ________________________
Category: ⧠ SC ⧠ ST ⧠ VJ ⧠ NT ⧠ OBC ⧠ SBC ⧠ Open Nationality: _______________________
Father’s Name
Mother’s Name
Occupation ⧠ Business ⧠ Service ⧠ Farmer ⧠ Other ______________________
Annual Income __________________________________________
Permanent Address ______________________________________________________________________________________________
______________________________________________________________________________________________
Parents Contact 1. 2.
Local Address ______________________________________________________________________________________________
______________________________________________________________________________________________
Local Contact 1. 2.
Candidate Cell No
Candidate Email ID: ________________________________________________________________
Whether Hostel Facility is required ⧠ Yes ⧠ No
Whether Transport Facility required ⧠ Yes ⧠ No
If yes, mention the name of the stop _________________________________________________
Affix recent
Passport size
Photograph

2. INTERNATIONALCENTRE OF EXCELLENCE IN ENGINEERING
AND MANAGEMENT AURANGABAD (ICEEM) 2516
CEEM
Expanding Horizon
Details of Academic Record (10th / 10th + 2 / Diploma / Graduation)
Name of
Examination
Year of
Passing
Board / University Marks
Obtained
Maximum
Marks
%
tage
CET
Score
10th SSC
12th HSC
Diploma
Name Of Entrance Examination:- _________________________________ Score _______________________________
Documents Attached Original & 2 Photo Copies each
⧠ SSC Certificate ⧠ HSC Marksheet ⧠ JEE Mains Score Card
⧠ CET Exam Score Card ⧠ Diploma Final Year Marksheet ⧠ Allotment Letter
⧠ Nationality Certificate ⧠ TC (College Leaving Certificate) ⧠ Caste Certificate
⧠ Caste Validity ⧠ Non Creamy Layer Certificate ⧠ Handicap Certificate
⧠ Income Certificate
UNDERTAKING
1. I undertake, That I shall abide by the rules and regulations prescribed by the College / University / DTE / Authorised
bodies from time to time
2. My admission will be immediately cancelled, if any information given by me is found to be incorrect or false
3. To complete the requisite internship / training during the period of the course
4. That I will keep away myself from ragging as it is strictly prohibited by law
5. If there is change in fees from Govt authority then it will be applicable for the students to pay the difference
Signature of Parent _____________________________ Signature of Candidate __________________________
FOR OFFICE USE ONLY
Date of Admission: Admission Receipt NoCourse:
INSTALMENT IF APPLICABLE:-
Amount
1st Time at rhe
time of
Adminission
2nd Time (Date 15-10-23) 2nd Time (Date 15-1-24)
Director Sign:- Seal & Signature of Admission Authority
Fees
Details
TUITION
FEES
DEVELOPMENT
FEES
SECURITY
DEPOSIT
UNIVERSITY
FEES
TOTAL
FEES
SIGN OF
ACCOUNTANT
FULL FEES
APPLIED
FEES

3. INTERNATIONALCENTRE OF EXCELLENCE IN ENGINEERING
AND MANAGEMENT AURANGABAD (ICEEM) 2516
CEEM
Expanding Horizon