Application

APPLICATION FOR ADMISSION TO POLYTECHNIC DIPLOMA COURSE 2024 - 2025

Name of the Candidate (In block letters) *

Email *

Mobile *

Photo *

Date of Birth *

Age *

Gender *

Nationality *

Religion *

Community *

Category *

Blood Group *

Aadhar Number *

Permanent address is same as address for communication

Permanent Address *

Address For Communication

Signature of the Applicant *

Quota *

Place *

Fathers Name *

Fathers Occupation *

Fathers Mobile No

Mother's Name *

Mother's Occupation *

Mother's Mobile No

Annual Family Income *

Guardian's Name

Relation with Guardian

Guardian's Mobile No

Signature of the Parent *

Name of the Institution last studied *

Board of Study ( HSC / CBSE /VHSE /ICSE / if others specify )*

Details of Marks secured in the SSLC examination

Month & Year of passing *

SSLC Mark List *

Total Percentage : *

Note: Enter the grade of any subject as per the order given in the marklist

Add Subject

Subject *

Grade *

Details of Marks secured in the plus two examination

Month & Year of passing

Plus 2 Mark List

Grand Total :

Total Percentage :

Course Preference 1 *

Course Preference 2

Course Preference 3

Declaration

We, the applicant & parent / guardian do hereby declare that all the information furnished above are true and correct and we will obey the rules and regulations of the institution, if admitted. Also we understand that the admission shall be, subject to satisfying the eligibility norms prescribed by the Statutory Authorities and the state Govt. from time to time.

I agree