Survey. No. 123 & 124, MIT-WPU Campus, Paud Road, Kothrud, Pune – 411 038.

Phone: - 020-25703400 Fax 020-25442770, Website: https://mitwpu.edu.in, Email: [email protected]

Application form for seeking admission for Academic Year 2024-2025

PRN - Faculty School of Design
Academic Level GRADUATE Program B.Des. Fashion and Apparel Design
Class/Std. FY B.Des- Fashion Admission OTHER
Category
Seat Type All India Quota Domicile OMS

Sir/Madam,
I am applying for admission for GRADUATEprogram under the School of Design at Dr. Vishwanath Karad MIT World
Peace University [MIT-WPU], Pune for the academic year 2024-2025 . The details of my candidature are as
below.

Personal Information
1) Student Name : Gayathri C
( Name as per previous mark-sheet )

2) Gender Female 3) Blood Group : O+

(M/F/T) :
4) Category : OPEN 5) Nationality : INDIAN
6) Mobile No. : 917812861429 7) Email ID : [email protected]
8) Present Address : No4 Dream Villa, Sri Sai Nagar 1st Street India, Tamil Nadu,
Kanchipuram, Kanchipuram,
State : , Pin Code : 600097
9) Permanent No4 Dream Villa, Sri Sai Nagar 1st Street India, Tamil Nadu,
Address : Kanchipuram, Kanchipuram,
State : , Pin Code : 600097
10) Aadhar No. : 449352717955 11) Passport No. : Y3571209

Foreign Students Information [Applicable for NRI/PIO/OCI/FN students]

Particulars Number Issue Date Expiry date
Passport Y3571209 11/06/2034
Visa ( Visa Type - )
Police Verification [RP]

Exam/ Result Details:

I. Educational Details [Attach a photocopy of mark-sheet(s)]:

Class Name of Board/ University Exam. Seat Month & Year of Total Marks/ Credits Total Marks/ CGPA
 No Passing earned out-off
10th Central Board Of Secondary 01/2020 439 600
std. Education (Cbse)
12th Central Board Of Secondary 01/2022 373 500
std. Education (Cbse)

II. 12th PCMB/ Technical Vocational Subject Obtained [If out of 200,pl. convert marks in out 100] :
Physics : 63 / 100 Chemistry : 68 / 100 Mathematics : __ / 100
Biology : 74 / 100 Tech. Voc : __ / 100 Eligibility Marks :

III. Qualifying entrance examination details [Attach a photocopy of mark-sheet(s)] :

Exam Application ID Marks/Percentile earned Marks/Percentile out off
CBT 003416 52 100

Information as per previous Transfer/ Leaving Certificate :

1) Name of previous college/ School Sree Chithirai Thirunal Residential Central School
attended :
2) Date of birth : 01/04/2004 3) Place of Birth : Thiruvananthapuram Kerala
4) Religion : HINDU 5) Caste & Sub Desigar Brahmin
Caste :
6) Nationality : INDIAN

Parent’s Information :
1) Father’s Name
Surname : Kumar First Name : Desigar Middle Name :
Mobile No. : 9944708010 Occupation : BUSINESS
Employment Paying Guest Hostel Designation : Owner
Sector :
Organization Name & Osr Paying Guest Hostel
Address :
Email ID : [email protected] Alternate 9944708010
Contact No :
2) Mother’s Name
Surname : S First Name : Deepa Middle Name : Rani
Mobile No. : 7708866109 Occupation : HOME MAKER
Employment Designation :
Sector :
Organization Name &
Address :
3) Guardian’s Name
Surname : S First Name : Deepa Middle Name : Rani
Mobile No. : 7708866109 Guardian relation GUARDIAN
with candidate :
 **** DECLARATION ****

I, hereby, declare that :

1) I have not been debarred from appearing any examination held by any Government constituted or
statutory examination authority of India.
2) I have not been involved or no prosecution is pending against me regarding copying in examination
or any case of misconduct at any University.
3) In the middle of the academic year, I shall not ask for transfer from MIT-WPU to any other
University or from allotted existing branch to another branch under any circumstances.
4) The information furnished in the application form/admission record are true/ correct to the best of
my knowledge. If any of the information provided by me found incorrect, my admission shall be
cancelled, and I shall be liable for disciplinary action in accordance with rules and regulations of the
MIT-WPU.
5) I will abide by the rules and regulations in force at present as well as those may be enacted and
enforced in future by the University, so long as I am the student of MIT-WPU.
6) I will do nothing either inside or outside the university that will interfere with the ordinary
governance and discipline of the university.
7) After completion of this academic year @ MIT-WPU, If I failed in the examinations and not found
eligible for admission to higher class, I shall contact in person; for completing further formalities.
8) I will remain regular in all respect and attend all the theory lectures and practical throughout the
year. I am also aware about the University timings/ shift timings and if my overall attendance is less
than 90% my academic term will not be granted.
9) In case I fail to pay the fees in time, I may not be allowed to appear the classes, respective exam that
is due and I will not object to such decision taken by the university.
I have read and agreed for the above terms and conditions.

Date: __/ __ / _________ Student’s Signature

Gayathri C
-------- FOR OFFICE USE ONLY --------

Signature with Date : Signature with Date :

Form verified by : Fees verified & received by :
 UNDERTAKING BY STUDENT AND PARENTS

I/We the undersigned Mr./Mrs. Kumar Desigar am/are, father/mother /parent /guardian of Mr./Ms.
Gayathri C ,of Class: REGULAR Year of GRADUATE Branch: B.Des. Fashion and Apparel
Design, my/our ward having been admitted to Dr. Vishwanath Karad MIT World Peace University, Pune. I/We
have read and are fully aware of the following regulations and norms of the University and hereby
undertake to strictly abide by the same.
For Student:
1. That, I shall attend the classes’ right from the first day of the Term as per the Time Table.
2. That, minimum attendance required as per the MIT-WPU is 90% for granting of the Term. I shall
attend all the Theory and Practical classes sincerely and regularly without fail for achieving excellence
in Academics. I know that no special consideration is given even on Medical grounds without due
certificate form registered medical practitioner.
3. That, I shall not involve directly or indirectly in any kind of RAGGING and anti-social activities. I
am fully aware that ragging is an offence punishable by the law, resulting in imprisonment and / or
heavy penalty. If found involved in any such activity directly or indirectly, I shall not only be expelled
from the University, but the matter will be reported to the appropriate police authorities, for further
action.
4. That, I am required compulsorily to submit assignments and appear for Tests in every subject with
full preparation, for grant of Term.
5. That, I shall complete all the assignments after thorough preparation & I shall neither copy the same
from others nor show others to copy my assignments.
6. That, I shall read and follow all the instructions given by the University from time to time through its
Notice Boards, SMS, E-mail, MIT-WPU Website, Announcement Systems, Oral Communications, etc.
7. That, I shall strictly maintain punctuality while attending all the Theory and Practical Classes.
8. That, I shall put-on my University I-Card on every day without fail and will attend the classes in full
University uniform on the specified days and on special occasions.
9. I shall dress my hair properly and put on a neat, decent formal dress of Trouser and Shirt / Salwar
Kurta (for girls) every day; other than uniform days.
10. I shall not wear any objectionable / indecent dress / clothes like low waist jeans, 3/4th jeans or any
shabby looking tight dress during or after the working hours of the University, on the campus.
11. I shall participate in all curricular, co-curricular, extra-curricular, social, cultural and adventure
activities at my own risk. In case of any unfortunate event, accident, any type of injury or fatal casualty,
University / Management / Faculty / Staff will not be held responsible under any circumstances. I
understand that any breach of the above rules, regulations and norms may result in disciplinary action
and even non-granting of my Academic Term.
12.I understand that, any admission secured as a reserved category candidate given against quota,
reserved for backward class category is purely provisional and can be cancelled if the caste certificate
is cancelled / rejected / invalidated by any Govt. Authority, admission authority or the University and
subject to submission of Caste Validity Certificate and / Non-Cream Layer Certificate (as applicable).
13. I will not directly or indirectly get involved in any such behavior which would adversely affect my
image and/or the image of the University, failing which I shall be liable for the disciplinary action
which may result into cancellation of my admission.
14. I have read all the rules and regulations framed by the University regarding Discipline and Code of
Conduct which are in force and made applicable by the Management of MIT-WPU, Pune and I promise
to abide by the same.

Student’s Full Name & Signature I agree with the contents of Undertaking signed
by my ward and advise him/ her to abide by the
Gayathri C above clauses.

Place:________________ Full Name & Signature of the

Date: __ / __ / ____ Parent’s/Guardian’s
Kumar Desigar
 MIT-WPU
UNDERTAKING ON CODE OF CONDUCT
PENALTY / PUNISHMENT ON VIOLATION OF CODE
CODE OF CONDUCT / RULES & REGULATIONS
OF CONDUCT
1. University Identity Card i) Fine of Rs. 500/-.
a) Students are required to put on Student Identity Card all the ii) No entry in the classroom or use of facilities for the day.
time within the campus premises.
2.Attendance & Academic rules i) In case, the attendance of the student falls below 75%, then
a) Students are expected to attend each and every Lecture, the said student will not be eligible to appear in the Term –
Tutorial and Laboratory practical sessions. However, due to End Examination.
contingencies, 90% attendance is mandatory. In addition, 10% ii) Loss of Term.
grant of exemption in attendance based on extraordinary cases iii) Debarment from receiving any scholastic award and/or
like sickness, hospitalization, death of immediate family Scholarship of the University.
member. Furthermore, 5% exemption in attendance can be iv) Cancellation of Admission.
granted by Vice Chancellor (VC) on the recommendations of
Dean as per the statutes of the University.
b) Use of cell phones during Lectures, Tutorials, Laboratory
Practicals, Examinations is strictly prohibited.
c) Involvement in Unfair Practices such as copying,
plagiarism etc. is strictly prohibited and will be dealt as per
the rules of the Academic and Examination ordinances of the
University.
3. Dress Code i) Attendance won’t be marked for the entire day for the first
a) Students are required to attend the classes in full University instance.
Uniform on specified days and on special occasions of the ii) Social Project duration of 15 - 20 hours for second and
School/ University, including National Days, Guest Lectures, subsequent instances.
Seminars, Conferences and other gatherings.
b) On other days, descent formal dress to be worn by the
students. (Tight, shabby and revealing clothes, Sleeveless and
Off-Shoulder Tops, T-Shirts without collars, Low waist jeans,
Half-pants, shorts, short skirts, slippers and objection
able/indecent dresses are not allowed).
4. Anti-Ragging i) Zero Tolerance Policy.
a) Ragging, in any form, is strictly banned in the University ii) Suspension till pending enquiry.
campus and hostel premises as per law. iii) Disciplinary Action including rustication.
iv) Case may be reported to Police authorities for legal action
as per the provisions of Indian Penal Code.
5. Alcohol, Drugs and Smoking i) Zero Tolerance Policy.
a) The unlawful possession, consumption, purchase or ii) Suspension till pending enquiry.
distribution of alcohol, cigarettes, e-cigarettes, illicit drugs, iii) Disciplinary Action including rustication.
controlled substances (including stimulants, depressants, iv) Case may be reported to Police authorities for legal action
narcotics, or hallucinogenic drugs) or paraphernalia or the as per the provisions of Indian Penal Code.
misuse of prescription drugs including buying, sharing or
consuming is strictly prohibited in the University campus and
hostel premises.
6. Assault, Endangerment or Infliction of Physical Harm i) Suspension till pending enquiry.
a) Physical restraint, assault or any other act of violence or use ii) Disciplinary Action including rustication.
of physical force against any member of the campus or any act iii) Case may be reported to Police authorities for legal action
that threatens the use of physical force as per the provisions of Indian Penal Code.
7. Discrimination, Including Harassment, Based on a i) Zero Tolerance Policy.
Protected Class ii) Suspension from attending classes pending enquiry.
a) Discrimination, including harassment, based on an iii) Disciplinary actions as per the directives of the Discipline
individual’s sex, race, colour, age, religion, national or ethnic committee.
origin, sexual orientation, gender identity or expression, iv) Case may be reported to Police authorities for legal action
pregnancy, marital status, medical condition, veteran status, as per the provisions of Indian Penal Code
disability or any other legally protected classification.
8. Disorderly Conduct i) Debarment from receiving any scholastic award and/or
a) Excessive noise, which interferes with classes, school Scholarship of the University.
offices, neighboring societies or other activities. ii) Suspension from attending classes pending enquiry.
b) Unauthorized entry into a restricted area or a closed iii) Disciplinary actions as per the directives of the Discipline
meeting. committee.
c) Conduct that restricts or prevents faculty, staff or student iv) Repeat instances may result in expulsion from the
employees from performing their duties, including University with no refund of Fee paid.
interruption of meetings, classes or events.
d) Any other action(s) that result in unreasonable interference
with the learning/working environment or the rights of others
9. False Representation i) Expulsion from the University with no refund of fee paid.
a) Provide false information or make misrepresentation to any
school office, forgery, alteration, or unauthorized possession
or use of school documents, records, or instruments of
identification, forged or fraudulent communications (paper or
electronic mail).
10. Fire Safety i) Debarment from receiving any scholastic award and/or
a) Tampering, interference, misuse, causing damage and/or Scholarship of the University.
destruction of fire safety and fire prevention equipment. ii) Suspension from attending classes pending enquiry.
iii) Disciplinary actions as per the directives of the Discipline
committee.
iv) Repeat instances may result in expulsion from the
University with no refund of Fee paid.
11. Theft, Vandalism, or Property Damage i) Suspension from attending classes pending enquiry.
a) Theft, negligent, intentional, or accidental damage to ii) Disciplinary actions as per the directives of the Discipline
personal or school property. committee.
b) Defacing of Campus property by means of Banners, iii) Twice the Full Recovery towards the damage.
Chalking and Posters. iv) Debarment from receiving any scholastic award and/or
Scholarship of the University.
v) Repeat instances may result in expulsion from the
University with no refund of Fee paid.
12. Weapons and Fireworks i) Zero Tolerance Policy.
a) Possession or use of firearms including rifles, shotguns, ii) Expulsion from the University with no refund of fee paid.
handguns, air guns, and gas-powered guns and all ammunition iii) Case may be reported to Police authorities for legal action
or hand-loading equipment, knives etc. as per the provisions of Indian Penal Code.
b) Possession or use of fireworks, dangerous devices,
chemicals, or explosives.
13. Parking of Vehicles in the campus i) Fine of Rs.500/-, each time, for parking vehicles other than
a) No vehicle will be allowed in the campus without authentic the allotted area.
stickers provided by the MIT-WPU. ii) Tyres of the vehicle will be flattened by the
b) Area for parking of staff vehicles and student’s vehicles are parking/security authorities if vehicles found on wrong
defined and allotted. parking allotment or vehicle parked in improper manner.
c) The students should park their vehicles in the allotted area iii) Two-wheeler should not be parked on side stand,
only. otherwise parking/security authorities will flatten the tyre.
d) The student should not park their vehicles in parking
slot/area allotted for staff of MIT-WPU in any circumstances.
e) If the Parking is full and there is no vacant space, then the
student should park the vehicles outside MIT-WPU campus at
their own risk.

I have read all the above-mentioned code of conduct / rules and regulations and penalty / punishment on violation of the
same as framed by the University regarding Discipline and Code of Conduct which are in force and made applicable by the
Management of MIT-WPU, Pune and I promise to abide by the same.

I have also informed the contents of the above-metioned Undertaking to my parents/guardian.

Dated: __ / __ / _________ Student’s Full Name & Signature

Gayathri C

Place: (PRN No.)

-
 ANTI-RAGGING - UNDERTAKING

I, Mr/Ms. Gayathri C [Student’s Name], Son of Mr./Mrs. Kumar Desigar [Parent’s Name] Class: REGULAR of
GRADUATE program., Branch: B.Des. Fashion and Apparel Design having been admitted to Dr.
Vishwanath Karad MIT World Peace University, Pune,

and
I, Mr./Mrs. Kumar Desigar [Parent’s Name], father /Mother /Parent /Guardian of Mr./Ms. Gayathri C [Student’s
Name], Class: REGULAR of GRADUATE program, Branch: B.Des. Fashion and Apparel Design , my

ward having been admitted to Dr. Vishwanath Karad MIT World Peace University, Pune.
1. We have received a copy of the UGC Regulations on “Curbing the Menace of Ragging in Higher
Educational Institutions 2009”, (hereinafter called the “Regulations”). We have carefully read and fully
understood the provisions contained in the said Regulations.
Url: UGC REGULATIONS ON ANTI RAGGING.
(https://www.ugc.ac.in/oldpdf/ragging/minuterag230409.pdf)
2. We have, in particular, perused clause 3 of the Regulations and am aware as to what all constitute
ragging.
3. We have also, in particular, perused clause 7 and clause 9.1 of the Regulations and am fully aware of
the penal and administrative action that is liable to be taken against me / my ward in case I / my ward
found guilty of or abetting ragging, actively or passively, or being part of a conspiracy to promote
ragging.
4. We hereby solemnly aver and undertake that:
i. I / My ward will not indulge in any behavior or act that may be constituted or considered as
ragging under clause 3 of the Regulations.
ii. I /My ward will neither participate nor abet or propagate through any act of commission or
omission that may be constituted as ragging under clause 3 of the Regulations.
5. We hereby affirm that, if found guilty of ragging, I/ my ward shall be liable for punishment
according to clause 9.1 of the Regulations, without prejudice to any other criminal action that may be
taken against me / my ward under any penal law or any law in force at that time.
6. We hereby declare that I have not been expelled or debarred from admission in any institution in the
country on account of being found guilty of, abetting or being part of a conspiracy to promote ragging;
and further affirm that, in case the declaration is found to be untrue, I am aware that my / my ward’s
admission is liable to be cancelled. Declared this on ________________________ day, date: __/ __ /20
.
We have read and agree with the contents of Undertaking signed by me/my ward.

Signature of Father /Mother /Parent /Guardian with Signature of student with name
name Gayathri C
Kumar Desigar
Place:________________
Date: __ / __ / ____
 SELF-DECLARATION

I have passed qualifying examination prescribed for the programme mentioned in this application form
for which I wish to take admission. Also, I confirmed that I am fulfilling the eligibility criteria of the
programme as per the norms of the MIT-WPU failing which my provisional admission will stand
cancelled and I will not dispute the cancellation of my admission.
I shall produce the educational certificates / mark sheet in original for credential verification within a
week from the date of my admission / on or before 30th September _______(of current academic year).
of this calendar year, failing which I shall forfeit my admission claim/ seat.
I am aware that my admission is provisional in nature & it will be confirmed upon fulfilling the
eligibility criteria & payment of full fees as prescribed by the MIT-WPU.
I have read and agreed for the Fees Refund Policy defined by MIT-WPU which is in line with the UGC
refund policy against cancellation of Admission.
I/We undertake that I/We, in case cancellation of admission of may ward, shall accept the decision of
the University about the refund of fees as the rules mentioned.
I shall read and follow all the instructions given by the University from time to time through its Notice
Boards, SMS, E-mail, MIT-WPU Website & any other official communications.
I shall participate in all curricular, co-curricular, extra-curricular, social, cultural and adventure
activities at my own risk. In case of any unfortunate event, accident, any type of injury or fatal casualty,
University / Management / Faculty / Staff will not be held responsible under any circumstances.
I understand that, any admission secured under backward class reserved category is purely provisional
and can be cancelled if the caste certificate or caste validity certificate is cancelled / rejected /
invalidated by any Govt. Authorities and will be confirmed subject to fulfilling of eligibility criteria,
submission of mandatory documents in the Admin Office of the University along with the Caste
Validity Certificate and Non- Cream Layer Certificate (as applicable).
I will not directly or indirectly get involved in any such behavior which would adversely affect my
image and/or the image of the University, failing which I shall be liable for the disciplinary action
which may result into cancellation of my admission.
I hereby declare that my admission may be cancelled or I may be suspended, expelled or debarred from
the University on account of being found guilty of, abetting or being part of a conspiracy / common
offs such as mass bunking, hooliganism, attempt to defame MIT-WPU on Social media / print and
electronic media, misleading and enticing fellow students to stage illegitimate protest against university
on account of false assumptions, misinterpretation of university rules and regulations.
I also declare that any issue related to admissions, student affairs, fees, academics, examinations,
administration etc. shall be resolved bilaterally only (between students /parents and university
authorities) through university grievance redressal mechanism and I or my parents shall not involve
any third party (individual or organizations / associations) for necessary resolution of the grievance.
Non adherence to this declaration may result in suspension or expulsion from the university.
I have not been debarred from appearing any examination held by any Government constituted or
statutory examination authority of India.
 I have not been involved or no prosecution is pending against me regarding copying in examination or
any case of misconduct at any University.
In the middle of the academic year, I shall not ask for transfer from MIT-WPU to any other University
or from allotted existing branch to another branch under any circumstances.
The information furnished in the application form/admission record are true/ correct to the best of my
knowledge. If any of the information provided by me found incorrect, my admission shall be cancelled,
and I shall be liable for disciplinary action in accordance with rules and regulations of the MIT-WPU.
After completion of this academic year @ MIT-WPU, If I failed in the examinations and not found
eligible for admission to higher class, I shall contact in person; for completing further formalities.
I/ We are aware that MIT-WPU is a self-financed state private university & abide to pay full fees of the
program as per the fee payment schedule prescribed by the MIT-WPU.
I understand and accept that, I may not be allowed to attending the lectures / practical / Placement
process / appearing the Examinations and or representing the University in co-curriculum and extra co-
curriculum activities if I fail to fulfill the eligibility criteria and or payment of fee on or before due
date.

We have agreed with the contents of Student-Self Declaration signed by me & my ward.

Signature of Father /Mother /Parent /Guardian with name

Kumar Desigar
Signature of student with name
Gayathri C
Place:________________
Date: __ / __ / ____