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:http://wwwmrtaclk/itum
(ii) "
NDT Admission - 2002/ 2003

I : (II) - +
- 20020802

Director, Institute of Technology, University of


Moratuwa, Katubedda, Moratuwa

For office use only


Application No.

(iii)
Director, Institute of Technology, University of Moratuwa,
Katubedda, Moratuwa

(iv)
( 1) ( 2)

+

42 - +
150 (
) ("

300 ) Institute of Technology, University of Moratuwa, A/C No.


300801412 +

43 -
2002 30
5 -
( )


6 '- (i)
+

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(9" x 4 1/ 2")

Period of Attendance
Year

Name & Address Administrative


of School
District
Y

From
to
M D Y
M

SPECIMEN APPLICATION FORM


Application for Admission to the National Diploma in
Technology Course Institute of Technology, University of
Moratuwa
ACADEMIC YEAR - 2002/2003

10
11
12
13
1st attempt

Application forPlease tick ( )


One or Both

(a) Maritime Fields (SET 1)


(b) Other Fields (SET 2)

2nd attempt
3rd attempt
11. Field Preference :

(See item 11 for details of fields in SET 1 and SET 2, Application


fee for SET 1 or SET 2 is Rs. 150 and for SET 1 and
SET 2 is Rs. 300)

SET 1 - Insert order of preference as 1 for first preference and


2 for second preference.
This should be completed only by the candidates who have
applied for Maritime Studies.

(All cages must be completed in ENGLISH BLOCK CAPITALS


only)

SET 2- Insert order of preference as 1, 2, 3, 4, 5, 6, 7 "1" for the


most preferred 2 for the next, and so on 7 for the last
preferred.

01. Last Name of Applicants :


02. Initials :
03. Names denoted by Initials :

SET 1
Maritime Fields

04. Contact Address :.

Prefer.

Marine Engineering Technology

(Please enclose two self - addressed 9"X4 1/2" envelopes)


Nautical Studies and Technology

05. Date of Birth

Year

Month

Date

(Special Medical Test and Interview for SET 1)

(Please enclose a certified copy of the Birth Certificate)


06. Are you below 24 years on closing date:
Yes
No
Please tick( )

SET 2
Other Fields

Prefer.

07. National Identity Card No.


Chemical Engineering Technology

(Please enclose a certified copy of the ID card)


08. Sex :

Civil Engineering Technology


Electrical Engineering Technology

Male
Female

Please tick ( )

Electronics & Telecom Eng. Technology


Mechanical Engineering Technology

[
1

10. School(s) attended from year 9 to 13 :


(Please enclose certified copy of school leaving certificates)

Polymer Engineering Technology

09. Results of G. C. E. (Advanced Level) Examination:


(Please enclose certified copies of A/L and Aggregate /Z - score
certificate for each of the attempts)

Textile & Clothing Technology

State Priority :
Grades & Details obtained at the

Subjects & Details


of Examination

Year 1999

Year 2000

Year 2001

Please tick ( )

SET 2
12. Have your been Registered at any University or Higher Educational Institution under the Ministry of Territory Education
and Training in Sri Lanka ?

Physics
Chemistry

SET 1

Yes/No

(Delete inappropriate)
(Do not leave blank)

Applied/Advanced
Mathematics
Pure/Combined

13. If the answer to (12) above is "Yes" please indicate the particulars of the course:-

Mathematics
Index No.
Medium
(Sinhala/Tamil)
Aggregate / Average

(i) Title of the course :.


(ii) Name of University :.
(iii) Academic Year :.
Registration Date :.
14. Applicants Declaration :

Mark or Z-score
A/L under New or
Old Scheme

Results of year to be considered for Selection (Indicate


whether 1999 or 2000 or 2001)

(i) I certify that all the particulars given by me in this application


are true and accurate. I am aware that if an particulars given by
me in this application are found to be false or inaccurate prior
to my admission, my application will be rejected and that if
such information is found to be false or inaccurate after my
admission, I will be discontinued from the course.

I : (II) - +
- 20020802
(ii) I am aware that if certified copies of Birth, A/L Aggregate/
Average/Z-score, School Leaving certificates and certified
copy of the National ID are not included with the application under any circumstances, the application will be
rejected.
(iii) In the event of my being selected for admission after the
Test, I shall abide by the Statutes, By-Laws, Regulations
and Rules of the Institute of Technology, University of
Moratuwa in so far as they are applicable to me.
(iv) I have enclosed a receipt obtained from a branch of Bank
of Ceylon, drawn in favour of Institute of Technology
University of Moratuwa, Account No. 300801412 to a
value of Rs. I also enclose two self-addressed envelopes.
.
Signature of Applicant.
Date :.
8-139

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