E FORM EVENING POLYTECHNIC

STUDENT NAME
FATHER NAME
MOTHER NAME
DATE OF BIRTH
GENDER (Male/Female)
PHONE NO
EMAIL ID
RELIGION
INCOME
SELECT YOUR PREFERRED COURSE
Automobile Engineering, Civil Engineering, Computer Science Engineering, Electronics and Communication Engineering, Electrical and Electronics Engineering, Mechanical Engineering
EXPERIENCE (Two Years / Two Years above)
ADDRESS
ADHAAR No
EDUCATION DETAILS     MAXIMUM
MARKS		 MARKS
OBTAINED
 

SSLC / 10th in karnataka
  CBSE / ICSE 10th
  10th in Non Karnataka
  ITI / PUC(Science)
Declaration of Applicant
I agree that confirmation my provisional selection and admission is subject to all my original certificate and declaration regarding caste, professional, income, etc.. Being found in a order and correct as per rules I also undertake that I am punishable as per rules in case it is found / provide that i have given any wrong / incorrect statement certificates for online admissions application