Sree Narayana Guru Polytechnic College

Madukkarai * Coimbatore 641 105

An ISO 9001-2008 Certified Institution

PHONE : 0422 - 2622368, 2622068 FAX : 0422 - 2622865

Email : sngit_guru@yahoo.com

Application Form for Admission to Diplomo Course - 20

Full Time Three Year Diplomo Course in Engineering

Application No:
Reg No:
Name of the Applicant:
(To be filled by applicant)
1.
a.
Name of the Candidate:
 
b.
Name of Parent/Guardian:
 
c.
Address for Communication:
 
 
PIN Code:
 
 
Telephone/Mobile no.:
2.
 
Sex:
3.
 
Date of Birth:
4.
 
Name of Caste / Religion:
5.
 
Community
6.
 
Nationality:
7.
 
Place of Birth:
8.
 
Mother Tongue:
9.
 
Parent Occupation:
10.
 
Annual Income:
11.
 
Proficiency in Sports:
12.
 
Examination Passed:
13.
 
*Aadhaar Card Number:
14.
 
*Bank Account Number.(SB):
15.
 
Details of School last studied:
Class Month & Year of Passing SSLC/Matric/CBSE Name & Address of the School
X
16.
 
Marks Obtained in SSLC/Equivalent Examination
SI.No Subject Secured Marks Maximum Marks Month & Year of Passing
1 Tamil (or) Other Language
2 English
3 Mathematics
4 Science
5 Social Science
6 Others - I
7 Others - II
8 Others - III
9 Others - IV
10 Others - V
Total
17.
 
Order of preference of course
Course CE MECH AE EE ECE CSE IT
Code Number
Declaration by the applicant

I declare that the information given in the application are true, correct and complete. If it is found otherwise, shall be liable to forfeit the seat / removal from the institution whatever stage of study besides making me liable for criminal prosecution.

Declaration by Parent / Guardian

I fully aware of the declaration made by the applicant and I declare and bind myself in the same term contained in the above declaration. The information given are true, correct and complete. If it is found otherwise, shall be liable to forfeit the seat / removal from the institution whatever stage of study besides making me liable for criminal prosecution.