MIT SCHOOL OF SUBSURFACE ENGINEERING
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- Megan Merritt
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1 INSTRUCTIONS FOR FILLING THE APPLICATION FORM 1. The application form can be filled in BLUE/BLACK ink. 2. Paste passport size coloured photograph in appropriate location. 3. Submit self-attested copies of the certificates supporting the educational qualifications. 4. Submit self-attested copies of the experience certificate. 5. Submit the undertaking/no-objection certificate in prescribed format (Page 7) duly signed by appropriate authority from your organization in original (applicable for employed professionals). The undertaking can also be submitted at the time of commencement of the course. 6. Fees to be paid in form of Demand Draft drawn in favour of MIT School of Subsurface Engineering. The fees can also be paid online. The account details for the same are as under: Name of the account: MIT School of Subsurface Engineering Bank Account Number: Bank: HDFC Bank Branch: Kothrud Branch Pune IFSC Code: HDFC
2 Application form 1. Name in Full: 2. Postal Address: Photo 3. Telephone No./ Mobile No.: 4. Address: 5. Permanent Address: 6. Date of Birth: 7. Academic Record: Degree University / Board Year of Passing 2
3 8. Work Experience: Name of the Organization Designation Experience (Years) Roles & Responsibilities 9. (a) I, hereby, declare that: i) I understand that my admission is provisional and may be cancelled by the Course Coordinator for reasons specified under general instruction. ii) The information given above is true to the best of my knowledge. (b) I hereby, undertake that i) If admitted, I will abide by the discipline rules and regulations in force at present or that may hereafter be made for the college and so long as I am student of the college, I will do nothing either inside or outside the college that will interfere with the ordinary governance and disciplines. ii) On selection for admission to this course, I will sign the requite undertakings as prescribed by the Management of the college. Date: Place: (Signature of the Candidate) 3
4 UNDERTAKING 1) I have read all the rules of admission for the current year and after understanding those rules, I have filled in this form of application for admission for current batch. 2) The information given by me in my application is true to the best of my knowledge and belief. 3) I hereby, agree to abide by the rules framed by the Institution and I, hereby undertake that so long as I am a student of the college, I will do nothing either inside or outside the college which may result in disciplinary action against me under the rules. 4) I fully understand that the Course Coordinator of the course, will have right to expel/ rusticate me from the course for any infringement of the Rules of conduct and discipline prescribed by the MIT School of Subsurface Engineering, Pune. Signature: Name of the candidate: Place: Date: 4
5 GENERAL INSTRUCTIONS 1. The admission once secured cannot be cancelled or transferred. 2. The fees charged for conduct of the course is INR /- plus 15% Service Tax. The amount to be paid will be INR /-. 3. The fees can be paid in form of Demand Draft or online as per the details mentioned earlier (page 1). In case of online payment of fees, the candidates or the sponsoring organization are hereby instructed to share the screenshot or payment reference number towards the fee payment on 4. If the candidate remains absent from the course and/or internship program for a continuous period of ten days without prior permission from the Course Coordinator (Prof. Dr. Sandeep Potnis), then the institute reserves the right to cancel his/her admission from the institute and the candidate will not be entitled for any refund of fees. 5. The fees once paid will not be refunded. However, in the event of cancellation of the course, fees will be refunded after deducting administrative expenses. 6. The fees mentioned in the course brochure are the fees charged for conduct of the course only. It excludes the travel and boarding costs during the internship in India and Austria. 7. The tentative cost estimate towards the travel and boarding costs for internship in India and Austria may be around INR /- to INR /-. The actual cost will be communicated at appropriate time. 8. The candidate undertakes that he/she has valid Indian Passport and is available for the internship in Austria. 9. The candidate undertakes that he/she is having necessary permissions from their organization to undertake the foreign study tour as a part of the internship programme. 10. MIT Pune may assist the candidate in processing the visa application for the international internship. However, it will not be the responsibility of MIT School of Subsurface Engineering, Pune and Montan University in case of rejection of the visa application of the candidate. 11. The dates and tentative cost estimate (Visa fees as well as air ticket fare) of the international internship will be informed to the candidate in advance. If required, MIT 5
6 School of Subsurface Engineering, Pune will assist the candidate in the booking of the air tickets. It has to be noted that MIT School of Subsurface Engineering, Pune and Montan University will not be responsible for the last minute reschedule or cancellation of the flight by the concerned carrier. 12. The candidate undertakes that he/she is medically fit to undertake the international study tour/internship. In case of any medical problem it is the duty of the candidate to inform the course coordinator in advance. In event the candidate conceals the medical condition, MIT School of Subsurface Engineering, Pune and Montan University will not be responsible in event of medical emergency. 13. MIT School of Subsurface Engineering, Pune and Montan University are not responsible for any accident or injury to the candidate during the course of internship in India and/or abroad. It is advisable that the candidate undertakes appropriate insurance policy as a cover for risks during the internship in India as well as Austria. 14. The commencement of the said program is subject to the minimum enrolment for the course. 6
7 (Format of the Undertaking to be submitted by the Candidate on his/her Organization Letter Head duly signed by Competent Authority of the Organization) UNDERTAKING/NO-OBJECTION CERTIFICATE TO WHOMSOEVER CONCERNED This is to certify that Mr./Ms. is working in our organization in the post of. He / She has been relieved to pursue the certificate programme in Tunnel Engineering at MIT School of Subsurface Engineering, Pune as per the programme schedule. The organization understands that Mr./Ms. will be subject to the rules and regulations of the Tunnel Engineering course for the entire course duration. The organization has no objection whatsoever in this regard. NAME: SIGNATURE: Place: Date: Seal of the organization: 7
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