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 Application Form
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Click here for eligibility & other details.
* Indicates Mandatory Field

Application for Admission to 4 Years (8 Semesters)
B.E. Degree Course in Engineering for the year 2006 – 2007.

1.  Name of the Candidate (in block letters)

2. Name of the Parent / Guardian
3. Postal Address (in block letters) Phone No. with STD
Email
4. Place of Birth
    Date of Birth
    Age
5. Nationality
    Religion
    Caste

6. Annual Income of Parents/Guardian (if parent is not alive)

7. Last College/School attended

    a) Date of leaving the Institution

    b) Highest Examination passed

 

a)

b)

8. Name of the University/Board last studied
9. Domicile State / Country

1. Karnataka

2. Non-Karnataka -

3. N.R.I. -

10. Branch of Engineering which the Applicant prefers to select (please tick)

1 . Civil Engg.

2. Mechanical Engg.

3 . Electrical & Electronics Engg.

4. Electronics & Commn. Engg

5. Comp.Science & Engg.

6. Information Sc. & Engg.
11. Previous Academic Career :  

Examn.

Name of
University /Board

No. of attempts to
pass the Exam

Year
of
Passing

Total
Marks
secured

a) P.U.C./ Inter

 
 

b) Diploma (3 yrs)

c) Other Examn. If any


Marks in optional Subjects

  Max.marks Marks Sec.

a) Physics

b) Maths

c) Chem.

Total : -
Percentage -
% age in final year -  

12. Institution at which the applicant studied during the last five years .  

Year

Class

Institution

Remarks

1.

12 th

2.

11 th

3.

10 th

4.

9 th

5.

8 th

Are the following attested copies of certificate enclosed ?

Matriculation Marks Card (10 th Std)
Qualifying examination marks card (12 th Std)
Transfer Certificate / College leaving certificate / Discharge Certificate
Medical Fitness Certificate from Doctor's registered with Medical Councils of any state.
Copy of Admission ticket / result sheet of KRLMPCA / AIEEE / Comed-K / Karnataka CET (if any).

 
 
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