Application Form
	Application Receiving Center
	Select district:		--Select District-- Ahmadnagar Akola Amravati Aurangabad Beed Bhandara Buldana Chandrapur Dhule Gadchiroli Gondiya Hingoli Jalgaon Jalna Kolhapur Latur Mumbai (P) Mumbai (U) Nagpur Nanded Nandurbar Nashik Osmanabad Parbhani Pune Raigad Ratnagiri Sangli Satara Sindudurga Solapur Thane Wardha Washim Yeotmal
	Select College:		--Select College Name-- Code:
	1. Personal Information
	Name Of Candidate: (As appearing on the statement of marks of the SSC(10h)/Equiv. Examination)
	First Name:
	Father's/Husband's Name:
	Last Name(Surname):
	Mother's Name:
	Gender :		Male Female
	Date Of Birth (YYYY/MM/DD)
	Address 1:		(Area)
	Address 2:		(City/District)
	Address 3:		(Pin Code)
	Contact No:		-(STD Code-Tel No)
	Mobile No:
	Email ID:
	Constitutional reservation (Caste recognized in Maharashtra State):		SC ST VJ NT-1 NT-2 NT-3 OBC SBC OPEN
	Name of Caste:
	I wish to claim reservation under:		DEF 1 DEF 2 DEF 3 MKB None
	Appearance Status:		Fresh Repeater
	Total Annual Family Income:		Up to Rs.1,00,000 Rs.100,001 - 2,50,000 Rs.2,50,001 - 4,50,000 Above Rs.4,50,000
	2. Academic Record
	a.Details of SSC (10th) Equivalent Examination
	Marks obtained in Maths at SSC/Equiv. Exam:		Marks obtained Out of
	Total marks obtained at the SSC/Equiv. Exam :		Marks obtained Out of
	b.Details of HSC (12th) Equivalent Examination
	Name of the Institute:		--Select College Name-- Code:
	3. Details required for DCT -12
	I Wish to Appear for following Subject/s in CET:		Physics Chemistry (* Compulsory)
			Mathematics Biology Mathematics & Biology
	I wish to Appear for:		Health Science(Med. Science)
			BVSc & AH (Veterinary)
			Engineering
			Pharmacy
	For Health Science Courses Region:		Rest of Maharashtra Marathwada Vidarbha None
	District Code:
	Service from Deeper:		1. DCT-12
			2. KASAUTI-12
			3. CET AIEEE-12
			4.Deeper Notes for PCB Deeper Notes for PCM Deeper Notes for PCMB None
			5.Notes delivered by ST Notes delivered by Courier Notes delivered by Hand None
			6.Goal Acheiver With Paper Set Goal Acheiver With DCT Goal Acheiver Separately None
	I have Appeared for Previous DCT:		2010 2011 None

4. These opinions are compulsory for decision making process in Govt. MHT-CET scenario. Incomplete form will not be accepted.

Q.1. Will it be convenient if exam is conducted immediately after 8 days from HSC exam. ? Yes No Can`t say Q.2. Do you feel form of Govt. MHT-CET is to be filled along with HSC form itself. ? Yes No Can`t say Q.3. Do you feel of Rs. 700/- charged by Govt. for Govt. MHT-CET is still high. ? Yes No Can`t say Q.4. Do you feel 50% HSC + 50% CET will be a proper solution for deciding Engg. and Med. Merit. ? Yes No Can`t say Q.5. Are you prepared for NEET (National Eligibility-cum-Entrance Test) this year (i.e. 2012). ? Yes No Can`t say Q.6. Do you feel sequence of exam PC-B-M should get changed to PC-M-B. ? Yes No Can`t say Q.7. Do you feel by not disclosing detailed merit list DMER and DTE is hiding transparency. ? Yes No Can`t say Q.8. Do you want answer keys of the Question Papers immediately after MHT-CET exam . ? Yes No Can`t say Q.9. Do you want your college to start CET cell. ? Yes No Can`t say Q.10. Does your college give detailed Admission Process Guidelines (APG) for Med. and Engg. ? Yes No

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