App Be
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SRI SHRIDEVI CHARITABLE TRUST (R)
Shridevi Institute of Engineering & Technology Affiliated to Visveswaraya Technological University & Approved by AICTE, New Delhi Vide 06/06/KTK/ENGG/02/017 Dt. 27-05-2002
S Sira i r a R o a d , T U Tumkur-572106, M K U R - 5 7 2 1 0 6 . K Karnataka, A R N A T A K A , IIndia N D I A Road,
Ph.: 91-0816-2212629, 2212627, 2211066, 2211768, Fax : 0816-2212629, E-mail : [email protected], website : www.shridevieducation.org
APPLICATION FORM
Branch:
No.
Name : Affix Latest Passport Size Photograph. Do not Staple / Pin the Photograph (Photograph not to be attested)
Name as entered in SSLC Date of Birth
Sex M
Age
Nationality
Religion
Sub Caste (If any)
Category
F
Caste
SC
ST
Father's / Guardian Name :
OBC
(Signature of the Candidate)
Occupation of Father / Guardian : Govt. / Private / Self Employed / Any others specify (If Parent is not alive)
Income. p.a
Job Details: Communication Address :
Phone No. with STD Code :
PIN
Permanent Address :
Phone No. with STD Code :
PIN
Details of Qualifying Examinations Name of the School / College last attended Highest Examination Passed Name of the University / Board last studied SUBJECT 1. English 2. Regional Language 3. Physics 4. Chemistry/Biology/BT/CSE/EC/IS 5. Mathematics Total of (3-5) Percentage of PCM
Max. Marks
Min. Marks
Marks Obtained
Are the following copies of the certificates enclosed a) SSLC / SSC / Xth Std. b) Marks card P.U. Course / Intermediate / c) Transfer Certificate d) Character & Conduct Certificate e) Migration Certificate f) Eligibility Certificate
YES / NO YES / NO YES / NO YES / NO YES / NO YES / NO
Note : Originals of the above shall be produced at the time of admission without which the admission is not complete Extra Curricular Activities (Enclose Certificate Copies) COMEDK/CET/AIEEE No.
COMEDK/CET/AIEEE Rank
Admn. Order No.
Category
Date of Issue
PUC / Inter. Reg. No.
DECLARATION 1. I do here by declare that the above information is correct. 2. I promise to abide by the rules and regulations of the college / institution and to the subject to their disciplinary action and if needed, I may be removed from the college in case of persistent break of disciplinary rules. 3. I understand original Certificates have to be submitted to Shridevi Institute of Engineering and Technology and these certificates will not be returned by Shridevi Institute of Engineering and Technology unless my full tuition fee is paid and all my dues are cleared. 4. I understand all the information concerned on conducting the course will be communicated through verifications displayed on the college notice board and no individual communication will be sent. 5. I shall not indulge myself in ragging in any form. 6. If admitted to Shridevi Institute of Engineering and Technology, I agree to abide by the polices, rules, laws and regulations of the college as modified from time to time. 7. I abide to maintain minimum 85% of Attendance, failing I may be detained for that semester. Date : Place : Signature of the Candidate
DECLARATION BY THE PARENT / GUARDIAN I certify that the above particulars furnished by my son / daughter / ward are correct and I undertake for the good conduct and to educate my son / daughter / ward in your institute till the completion of the B.E. degree course. I shall be responsible for the payment of all his / her dues, if any to the Govt. of Karnataka / University / Institution. Date : Place : Signature of the Parent / Guardian
FOR OFFICE USE ONLY Branch : ................................
Admission : ................................
Amount Paid in COMEDK/CET/AIEEE Rs. .............................................. Amount Paid in SIET Rs. ................................................
No. : ................................ Date ................................
Receipt No. ..................... Date ................................
Admission : Granted / Rejected
OFFICE SUPERINTENDENT
PRINCIPAL
Shridevi Institute of Engineering & Technology Affiliated to Visveswaraya Technological University & Approved by AICTE, New Delhi Vide 06/06/KTK/ENGG/02/017 Dt. 27-05-2002
S Sira i r a R o a d , T U Tumkur-572106, M K U R - 5 7 2 1 0 6 . K Karnataka, A R N A T A K A , IIndia N D I A Road,
Ph.: 91-0816-2212629, 2212627, 2211066, 2211768, Fax : 0816-2212629, E-mail : [email protected], website : www.shridevieducation.org
APPLICATION FORM
Branch:
No.
Name : Affix Latest Passport Size Photograph. Do not Staple / Pin the Photograph (Photograph not to be attested)
Name as entered in SSLC Date of Birth
Sex M
Age
Nationality
Religion
Sub Caste (If any)
Category
F
Caste
SC
ST
Father's / Guardian Name :
OBC
(Signature of the Candidate)
Occupation of Father / Guardian : Govt. / Private / Self Employed / Any others specify (If Parent is not alive)
Income. p.a
Job Details: Communication Address :
Phone No. with STD Code :
PIN
Permanent Address :
Phone No. with STD Code :
PIN
Details of Qualifying Examinations Name of the School / College last attended Highest Examination Passed Name of the University / Board last studied SUBJECT 1. English 2. Regional Language 3. Physics 4. Chemistry/Biology/BT/CSE/EC/IS 5. Mathematics Total of (3-5) Percentage of PCM
Max. Marks
Min. Marks
Marks Obtained
Are the following copies of the certificates enclosed a) SSLC / SSC / Xth Std. b) Marks card P.U. Course / Intermediate / c) Transfer Certificate d) Character & Conduct Certificate e) Migration Certificate f) Eligibility Certificate
YES / NO YES / NO YES / NO YES / NO YES / NO YES / NO
Note : Originals of the above shall be produced at the time of admission without which the admission is not complete Extra Curricular Activities (Enclose Certificate Copies) COMEDK/CET/AIEEE No.
COMEDK/CET/AIEEE Rank
Admn. Order No.
Category
Date of Issue
PUC / Inter. Reg. No.
DECLARATION 1. I do here by declare that the above information is correct. 2. I promise to abide by the rules and regulations of the college / institution and to the subject to their disciplinary action and if needed, I may be removed from the college in case of persistent break of disciplinary rules. 3. I understand original Certificates have to be submitted to Shridevi Institute of Engineering and Technology and these certificates will not be returned by Shridevi Institute of Engineering and Technology unless my full tuition fee is paid and all my dues are cleared. 4. I understand all the information concerned on conducting the course will be communicated through verifications displayed on the college notice board and no individual communication will be sent. 5. I shall not indulge myself in ragging in any form. 6. If admitted to Shridevi Institute of Engineering and Technology, I agree to abide by the polices, rules, laws and regulations of the college as modified from time to time. 7. I abide to maintain minimum 85% of Attendance, failing I may be detained for that semester. Date : Place : Signature of the Candidate
DECLARATION BY THE PARENT / GUARDIAN I certify that the above particulars furnished by my son / daughter / ward are correct and I undertake for the good conduct and to educate my son / daughter / ward in your institute till the completion of the B.E. degree course. I shall be responsible for the payment of all his / her dues, if any to the Govt. of Karnataka / University / Institution. Date : Place : Signature of the Parent / Guardian
FOR OFFICE USE ONLY Branch : ................................
Admission : ................................
Amount Paid in COMEDK/CET/AIEEE Rs. .............................................. Amount Paid in SIET Rs. ................................................
No. : ................................ Date ................................
Receipt No. ..................... Date ................................
Admission : Granted / Rejected
OFFICE SUPERINTENDENT
PRINCIPAL
