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The document is an application form for Harsh Raj, who is applying for a Master's program in Power and Control System Engineering. He has completed his 10th and 12th grades with high percentages and is currently pursuing a B.Tech in Electrical and Electronic Engineering. The application includes personal details, academic qualifications, GATE exam information, and payment details.

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Harsh Raj
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0% found this document useful (0 votes)
2 views4 pages

Bootstrap Example

The document is an application form for Harsh Raj, who is applying for a Master's program in Power and Control System Engineering. He has completed his 10th and 12th grades with high percentages and is currently pursuing a B.Tech in Electrical and Electronic Engineering. The application includes personal details, academic qualifications, GATE exam information, and payment details.

Uploaded by

Harsh Raj
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

HOME Application ID: MT26RFPC7926 LOGOUT

Personal Information

Full Name*

Harsh Raj

Gender*

Male

Father's Name*

Sanjay Kumar Chourasia

Date of Birth*

29-09-2003

Birth Category*

OBC(Non Creamy)

Address*

VILLAGE PACHGACHIA BAZAR PS GOPALPUR BLOCK GOPALPUR SUB DIVISION N

State*

Bihar

Nationality*

India

Pincode*

853204

Contact*

7667439018

Email*

2992003harsh@[Link]

Marital Status*

Unmarried

Disable Status*

No
Academic Qualification

10th/equivalent
Exam Passed School Name* Board Name* Passing Year*

10th/equivalent DIKSHA INTERNATIONA CBSE DELHI 2018

Percentage/CGPA* Out of* Complete Status* Notes If Any

96.20 100 Completed

12th/equivalent
Exam Passed School Name* Board Name* Passing Year*

12th/Equivalent GOVERNMENT POLYTEC SBTE BIHAR 2021

Percentage/CGPA* Out of* Complete Status* Notes If Any

85.32 100 Completed

Undergraduate
Exam Passed UG Degree Name* Discipline* College Name*

Undergraduate [Link] Electrical and Electronic DARBHANGA COLLEGE

University Name* Passing Year* Percentage/CGPA* Out of*

BEU PATNA 2025 84.83 100

Complete Status* Notes If Any

Completed

Postgraduate I (if any, leave blank if not applicable)


Exam Passed PG Degree Name Discipline College Name

Postgraduate Select Select

University Name Passing Year Percentage/CGPA Out of

Select Select

Complete Status Notes If Any

Select

Postgraduate II (if any, leave blank if not applicable)


Exam Passed PG Degree Name Discipline College Name

Postgraduate Select Select


University Name Passing Year Percentage/CGPA Out of

Select Select

Complete Status Notes If Any

Select

Any Other Degree (if any, leave blank if not applicable)


Exam Passed PG Degree Name Discipline College Name

Postgraduate Select Select

University Name Passing Year Percentage/CGPA Out of

Select Select

Complete Status Notes If Any

Select

Work Experience (Most recent first)

Experience-1 (if any, leave blank if not applicable)


Work Experience Type Organization Name Position From Date

Select dd-mm-yyyy

To Date Experience Duration Nature of Work Current Job

dd-mm-yyyy Select

Experience-2 (if any, leave blank if not applicable)


Work Experience Type Organization Name Position From Date

Select dd-mm-yyyy

To Date Experience Duration Nature of Work Current Job

dd-mm-yyyy Select

Experience-3 (if any, leave blank if not applicable)


Work Experience Type Organization Name Position From Date

Select dd-mm-yyyy

To Date Experience Duration Nature of Work Current Job

dd-mm-yyyy Select

[Link] Applying Details


Application Category* Department* Is Your [Link] from IIT*

Regular & Full-Time Power and Control System Engin No

Gate exam info


If you are applying the following category :
SPONSORED / PART-TIME category, then GATE score is not mandatory. In such case fill the the following default
values. If you have not given GATE exam then also fill the following default values:

1. Gate Registration No. (13 Character) : 1000000000000


2. Gate Score out of 1000 : 0
3. Gate Rank : 0
4. Coap ID. : K0000000
5. Gate Paper Code : Not Applicable (NA)
6. Gate Valid From : 01-01-2000
7. Valid Upto : 01-01-2000

GATE Registration No.* Gate Paper Code* COAP registration no.* Gate Score out of 1000*

EE26S54009068 Electrical Engineering ( 54009068 469

Gate Rank* Gate Valid From* Valid Upto* Notes If Any

3311 19-03-2026 31-03-2029

Payment info
Go to Payment and put the Payment Reference No. after successful Payment!!
Payment Amount

1. General/EWS/OBC-NCL: Rs. 1000


2. SC/ST/PwD/Women: Rs. 500

Payment Method* Payment Reference Number* Amount*

Direct Bank Credit DUP4472457 1000

Decalaration:
You can't edit this form later!!

I hereby declare that the entries made in this application form are correct to the best of my knowledge and
belief. If selected for admission, I promise to abide by the rules and regulations of the Institute. The Institute shall
have the right to take any action it deems fit, including expulsion, against me at any time after my admission, if it
is found that any information furnished by me is incorrect. I note that the decision of the Institute is final in
regard to selection for admission and assignment to a particular department and field of study.

Submit

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