Name of Candidate

Father’s Name

Mother’s Name

Date of Birth
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Course Applied for

Following are the choices of my preference for admission in B. Tech course for the Academic Session 2010-2011.
1 2 3

4 5 6

Residence Address

Telephone No.
(R) (Mobile) (Office)

E-mail address

Father’s Occupation
Company Name Designation

Mother’s Occupation

Merit Position

(i) U.P. SEE 2010

Category Rank State Rank

(ii) AIEEE

All India Rank State Rank

(iii) % of 10+2

(PCM) (PCB) (Over All)

(iv)% Graduation

For MBA, MCA MAT/CAT Score

I am enclosing herewith self attested photocopies of following

(i) 10+2 Examination Mark sheet
(ii) UP State Entrance Examination Result.
(iii) AIEEE Result.
(iv) Graduation Mark sheet
(v) ID/Address Proof (DL /Voter ID Card.
(vi) Income Tax PAN No.

Reference

(i) (ii)

Whether Hostel required
Yes No 

I understand that

>> That admission to the College is based on merit and I will deposit the non-refundable fee and appear for interview/counseling before the Admission Committee.
>> That ragging is an illegal and punishable offence/act and I will not involve in any ragging activity in campus during my study tenure.
>> That once registration done no adjustment/refund of fee is permissible for any reason whatsoever. The fee is provisional subject to revision any time.