This document is an admission form for the MIT School of Distance Education. It collects information such as the applicant's name, date of birth, contact information, program of interest, academic details, fee payment details, and required attachments. The applicant is requesting admission to a one-year or two-year postgraduate diploma program in various fields including business administration, engineering, management, and information technology. The form collects permanent and communication addresses, organization details for working professionals, academic qualifications, payment details, and a declaration of truth of submitted information and agreement to institute rules. Required attachments include documents proving identity, qualifications, photographs, and service records for defense or paramilitary personnel.

1. ADMISSIONFORM MAEER
TM
MIT SCHOOL OF DISTANCE EDUCATION
S. No. 124, Paud Road, Kothrud, Pune-411 038, India
Swapna Sant-9158990651, Rakesh Patil- 9158990650
Admission No.
To
The Director
Student Category
Civilian International student/NRI Defence Para-Military Police MIT Staff
Passport
Size
2 Photos
Birth Date :
First Name Middle Name Last Name
d d m m y y y y
I request for grant of admission to the belowmentioned program being offered by your institute for the academic year 20 .
(Tick the appropriate program)
Two Years Programs
Post Graduate Diploma in Business Administration (PGDBA) with specialization in
¨ Marketing ¨ Finance ¨ Human Resource ¨ Operations ¨ Information Technology ¨ Supply Chain ¨ Materials
One Year Program
¨ Post Graduate Diploma in Piping Design And Engineering
¨ Post Graduate Diploma in Fire And Protection Engineering
¨ Post Graduate Diploma in Energy Management
¨ Post Graduate Diploma in Risk & Insurance Management
¨ Post Graduate Diploma In Retail Management
¨ Post Graduate Diploma In Project Management
¨ Post Graduate Diploma In Marketing Management
¨ Post Graduate Diploma In Financial Management
¨ Post Graduate Diploma in Human Resource Management
¨ Post Graduate Diploma in Operations Management
¨ Post Graduate Diploma In Information Technology
¨ Post Graduate Diploma In Wealth Management
¨ Diploma In Business Administration
¨ Diploma In Retail Management
Address For Communication
(Students are required to give both the addresses)
Permanent Address
Address : Address :
City : State : City : State :
Country : Pin Code : Country : Pin Code :
Tel.: Mobile : Tel.: Mobile :
E-mail :
E-mail :
E-mail :
E-mail :
For MITSDE Use Only
Admission Status Form Status Date of Registration Registration Number
Confirmed Provisional C I

2. Address of Organization (for Working Professionals is compulsory)
(To be filled by Working Personnel only.) To be filled byDefence/ Para Miltary/ Police Personnelonly
Name & Address of the Organization : Service Number :
Rank / Cadre :
Total Service (years) Date of Commission / Enrolment:
Current Designation: Arms / Services : Army Navy Air Force
Contact Tel. No.: Total Service (years)
E-mail : (Personnel from Armed Force / Para Military/ Police are required to
attach a letter on official letterhead givingproof of services)
Academic Details (Degree / Diploma)
Examination Degree Institute / University Year of Passing Elective / Specialization Class / Division % Marks
Fee Details
I am remitting an amount of Rs / $ (Details are as below):
For Indian Residents : For Non Resident Indian / Foreign Residents:
1. Registration Fees : Rs. 1000
2. Prospectus Fees : Rs. 1000
3. Programme Fees : Rs.
1. Registration Fees : $ 100
2. Prospectus Fees : $ 100
3. Programme Fees : $
Total Fees : Rs. Total Fees : $
Mode of Payment : Cash (Only for Walk-in Submission) DD
DD No. Date : Bank Name :
Attested Xerox copy of following Documents Attached herewith (Please Tick) :
Degree Certificate Diploma Certificate Provisional Certificate Marriage Certificate Photographs 2 nos.
Service Certificate (in Case of Diploma holders or Defence / Paramilitary / Police) Photo Identity
Certificate of Undertaking
I declare that the information provided by me in this application form is true to the best of my knowledge. I am fully aware that in
case any information provided is found erroneous, it will result in cancellation of my registration / admission. I have read the
prospectus carefully and agree to abide by all the rules and polices of the Institute.
Place :
Date : (Signature of Applicant)
FOR MITSDE USE ONLY
Form filled completely
If no reason 1) 2) 3) 4) Certificates not
attached Graduation Diploma Provisional Other
Certificates not attached Form Incomplete / not signed Photographs not attached (2 nos)
Service certificate not attached Registration Fee not remitted.
(For diploma holder only& defence personnel only)