1. Enter your name *
2. Enter your parent/guardian name
3(a). Enter your address of communication *
3(b). Pincode*
4(a). Phone Number
4(b). Mobile Number *
4(c). Email ID*
5. Date of birth*
6. Gender MaleFemaleTransgender
7. Religion
8. Mother Tongue
9. Nationality IndianOther
10. Choice of branches in the order of preference * (a): Select BranchBE – Civil EngineeringBE – Mechanical EngineeringBE – Electrical & Electronics EngineeringBE – Electronic & Communication EngineeringBE – Computer Science EngineeringB.Tech – Information Technology (b): Select BranchBE – Civil EngineeringBE – Mechanical EngineeringBE – Electrical & Electronics EngineeringBE – Electronic & Communication EngineeringBE – Computer Science EngineeringB.Tech – Information Technology
11. Board of Examination* State BoardCBSEOthers
12. Medium of study
13. Name of the school
14. 12th Registration Number *
15. Month & Year of passing *
16. Marks
#(a) Marks in Maths to 50 (b) marks in Physics & Chemistry reduce 50 (c) Cut of Marks: (a)+(b)
17. Parents Details
Name:
Occupation:
Annual Income:
Phone Number
Mobile Number
18. List the outstanding sports/cultural achievements, scholarships received, prizes/honors won etc.
19. Height (cms)
20. Weight (kgs)
21. Blood Group
22. Aadhar Card No
23. Attachments (i). Copy of Transfer Certificate : (ii). Copy of 10th Marksheet : (iii). Copy of 12th Marksheet : (iv). Copy of Community Certificate : (v). Passportsize Photograph :
Station
Date
I declare that the information furnished in above is true and correct to the best of my knowldge.
