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This document is an application form for direct admission to engineering courses at polytechnics in Rajasthan for the year 2011-2012. The form requests information such as the applicant's name, parents' names, address, gender, date of birth, category, religion, academic records from secondary school and senior secondary school/equivalent exams, details of ITI certificate if applicable, and a signature agreeing to abide by the rules of the polytechnic. The form also includes a declaration by the applicant's father or guardian taking responsibility for the applicant's conduct and maintenance of discipline during their studies.

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Pawan Rathi
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117 views2 pages

Add Mission Form

This document is an application form for direct admission to engineering courses at polytechnics in Rajasthan for the year 2011-2012. The form requests information such as the applicant's name, parents' names, address, gender, date of birth, category, religion, academic records from secondary school and senior secondary school/equivalent exams, details of ITI certificate if applicable, and a signature agreeing to abide by the rules of the polytechnic. The form also includes a declaration by the applicant's father or guardian taking responsibility for the applicant's conduct and maintenance of discipline during their studies.

Uploaded by

Pawan Rathi
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

APPLICATION FORM FOR DIRECT ADMISSION IN ENGINEERING COURSES OF POLYTECHNICS IN RAJASTHAN ADMISSION 2011-2012

Registration No. Form No.

Admission Merit No. ___________


1. NAME OF CANDIDATE (IN ENGLISH) : _________________________________________ _________________________________________ (IN HINDI) : __________________________________________ __________________________________________

Affix Passport size Photograph of the candidate duly signed by candidate and attested by the principal or his nominee

2.

FATHERS / HUSBANDS NAME

: __________________________________________

3.

MOTHERS NAME

: __________________________________________

4.

POSTAL ADDRESS (Do not repeat name again)

:___________________________________________

___________________________________________

Dist. _________State_________Pin code___________

5.

SEX

MALE FEMALE

6.

DATE OF BIRTH

7.

CATEGORY OF RESERVATION

1 2 3 4

GENERAL SC ST OBC

5 6 7 8

SBC MP PH OTHERS

REGILION

: 1
2 3 4 5

HINDU MUSLIM SIKH CHRISTIAN OTHERS

9.

Whether you want admission under Tuition fee waiver scheme (TFWS) :

YES

NO

10. ACADEMIC RECORD:


SECONDARY / EQUIVALENT EXAM Sr. SECONDARY / EQUIVALENT EXAM Details of ITI Certificate Holder

Max. Marks Maths Science Aggregate of All Subjects Name of Board & Year of Passing Marks Improved?

Marks Obt.

Optional Subjects Maths Physics Chemistry Aggregate including compulsory subjects Name of Board & Year of Passing Marks Improved?

Max. Marks

Marks Obt.

Max. Marks Marks Obt. Name of Engg. Trade Duration Year of passing Name of Institute

Yes / No

Yes / No

Marks Improved?

Yes / No

It is certified that (i) All the entries in this form have been made by me and all are correct. I shall be responsible for any incorrect information provided by me. (ii) I have read all the information & rules given in the brochure. I shall abide by all the rules of the Polytechnic, Hostel and Board of Technical Education Rajasthan.

Signature of the Candidate

DECLARATION BY FATHER / GUARDIAN I ________________________________________ ( Fathers / Guardians Name) of the Candidate Sh. / Ms. ____________________________________ take all the responsibilities for his/ her conduct & maintainance of discipline of my Son / Daughter / Wife / Ward during the duration of his/her studies in the Polytechnic. The information given by him / her in the form are correct. Signature of Father / Guardian

FOR OFFICE USE Sr. No. 1 2 3 4 5 6 7 Eligibility Marks & Date of Birth Category Reservation Medical Certificate Branch Allotted College Allotted Allot Category Criteria Remark Signature

Fees Deposited Receipt No. DD No. & Bank / Cash Admitted / Not Admitted

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