Admission Form
Course Applied For Department
Name of the Applicant (in English)	:
Date of Birth	:
Address for Correspondence	:
Telephone	:
Cell	:
Email	:
Permanent Address (Full)	:
Telephone	:
Cell	:
Email	:
Category (Please Select)	:	Select GEN SC ST OBC PH Other
Education Qualification
Examination Year Board/University % Main Subjects Secondary (X) Select 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 HigherSec (XII) Select 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Graduation Select 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Other Degree / Certificate Select 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Father’s Name
Occupation
Cell
Email
Annual Income
Mother’s Name
Occupation
Cell
Email
Annual Income
Personal Information
Achievements
Hobbies
Passport No. (if any)
Voter ID No.
License No.
Health Details
Height
Weight
Blood Group
Disease, if any
Allergy, if any
Birth Mark
Reason for choosing the course
References of Relatives (Two)
Name Relation Qualification Occupation Work Place Monthly Income Contact No.
Conveyance Mode		Own College Bus