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SUBJECT Max. Marks Min. Marks Marks Obtained
E-mail : [email protected], website : www.shridevieducation.orgPh.: 91-0816-2212629, 2212627, 2211066, 2211768, Fax : 0816-2212629,
APPLICATION FORM
Shr idev i Ins t i t u t e o f Engineer ing & Tec hnology
SRI SHRIDEVI CHARITABLE TRUST (R)
Affiliated to Visveswaraya Technological University & Approved by AICTE,New Delhi Vide 06/06/KTK/ENGG/02/017 Dt. 27-05-2002
No.
1. English
2. Regional Language
3. Physics
5. Mathematics
4. Chemistry/Biology/BT/CSE/EC/IS
Total of (3-5)
Percentage of PCM
S i r a R o a d , T U M K U R - 5 7 2 1 0 6 . K A R N A T A K A , I N D I Ai ri r a R oR o a d ,d , T UT U M KK U RR -- 5 75 7 2 1 0 61 0 6 . K A RK A R N A T A KA T A K A ,, I N D I AI N D I A
Affix
Latest Passport Size
Photograph.
Do not Staple / Pin
the Photograph
(Photograph not to be
attested)
Name :
Name as entered in SSLC
Father's /Guardian Name :
Communication Address :
Phone No. with STD Code :
Date of Birth Age Sex M F
Nationality Religion Caste
Sub Caste(If any)
Category
(Signature of the Candid ate)
Permanent Address :
Phone No. with STD Code :
PIN
PIN
Income. p.a
Details of Qualifying Examinations
Name of the School / College last attended
Highest Examination Passed
Name of the University / Board last studied
STSC OBC
Occupation of Father / Guardian : Govt. / Private / Self Employed / Any others specify(If Parent is not alive)
Sira Road, Tumkur-572106, Karnataka, India
Branch:
Job Details:
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Are the following copies of the certificates encloseda) 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.
Admn. Order No.
Date of Issue
Date :
Place :
Signature of the Candidate
DECLARATION BY THE PARENT / GUARDIANI 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 t he Parent / Guardian
FOR OFFICE USE ONLY
Branch :
Amount Paid in COMEDK/CET/AIEEE Rs. ..............................................
Amount Paid in SIET Rs.
................................
................................................
Admission : Granted / Rejected
COMEDK/CET/AIEEE Rank
Category
PUC / Inter. Reg. No.
OFFICE SUPERINTENDENT PRINCIPAL
Admission : ................................ No. : ................................
Date ................................
Receipt No. ..................... Date ................................
DECLARATION1. 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.I abide to maintain minimum 85% of Attendance, failing I may be detained for that semester.7.