Application Form For Diploma in Engineering
APPLICATION FOR ADMISSION TO POLYTECHNIC DIPLOMA(3 YEARS) COURSE 2020-2021

( Fill in the blanks in BLOCK letters or put tick () wherever applicable

Admission Quota
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1. Name of the Candidate (in block letters)
2. Date of Birth
3. Age as on 01-01-2020
4. Gender
5. Nationality
6. Religion
7. Caste
8. Category
9. Blood Group
10.Aadhar number
11. Email
12. Permanent Address
Pin
Phone Number


13.Address For Communication
Pin
Phone Number
14(a). Father's Name
14(b). Occupation
14(c). Mobile No
15(a).Mother's Name
15(b) Occupation
15(c) Mobile No
16. Annual Income
17(a).Guardian's Name
17(b) Relation
17(c) Mobile No
18. Select the order of preference of branches offered
19. Name of the Institution last studied
20. Board of study
21. Details of Mark Secured in SSLC examination
21 a). Register No.
21 b).Month and year of passing
SubjectGrade
Total Percentage
PCM Percentage
22. Details of Marks secured in the plus two examination(If plus two passed)
22 a). Register No
22 b). Month & Year of passing
SubjectMark ObtainedMaximum MarksGrade
Grand Total
Total Percentage
Total PCM
PCM Percentage

Declaration

  • The above information is true to the best of my knowledge and belief and I understand that the admission shall be subject to satisfying eligibility conditions as per AICTE/DTE and Govt. of Kerala
Upload your Signature
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Upload Parent's Signature
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