Post on 14-Jun-2020
transcript
Estd. 1997
SKIETSKIET
frkZoH¼flfdetZ k
Shri Krishan Institute of Engineering & TechnologyAnd
Shri Krishan Polytechnic
Estd. 2005
SKPSKP
frkZoH¼flfdetZ k
Sirsla Road, Ratan Dera, P.O. Pipli, Kurukshetra 136 131 (Haryana) Approved by AICTE, DTE & Affiliatecd to Kurukshetra University
Registration/Admission Form(USE CAPITAL LETTERS ONLY)
Name:
Permanent / Correspondence Address: .......................................................................................................................
City: ........................................................ State:.......................................................... Pin Code ....................................
Contact No.(With STD Code):...........................................................Mob: ..................................................................
Email ID:.............................................................................................................................................................................
Affix YourRecent
Passport SizeColoured
Photograph
Course for which seeking admission (M.Tech - CSE, B.Tech - CSE, IT, ME, CIVIL, ECE), (Management -
MBA & BBA), (Diploma- CSE, ME, CIVIL, ECE, EE, AE):-
Category (SC/ ST/ OBC / GEN.) :
9.
7.
10. AIEEE/MAT CAT/ GATE / DET / LEET / DET-L (Tick as aplicable)Ö
Rank Roll No.
Sr. No. _____________
Course ................................................................. Direct/ LEET/DET-L .............................. Branch ...........................
8. Domicile State:
11. (a) Academic Record :
Sr. Exam Max. Marks
MarksObtd.
University/BoardYr. of
Passing Roll No. %age
1
2
3
4
10th
10+2 (PCM Only)
Graduation ..........................
Others ..................................
(b) Gap Years: ...................................................................................................
(c) Have you ever been disqualified from studies : YES/NO
1.
thFather's Name: ............................................................................................................................. (As given in 10 Certificate)5.
Date of Birth: 3. Sex (Tick Ö): Male Female 4. Nationality:........................2.
6.
Parent's & Guardian Details
Father
Mother
Occupation Contact Nos. & Email ID
12. Parents Information:
th(As given in 10 Certificate)
Place: .....................................
Date: .........../........../...............
...........................................Guardian's Signature(with relation & full Name)
...........................................
Student's Signature
FOR OFFICE USE ONLY
Details of Fee Deposited (Amount) Category : SC/ST/OBC/Gen.
by Draft / Cheque / Cash Receipt No. .................................. Bank .............................................. Date .........................
Registration No. ......................................... Roll No. .................................. Admitted to Course ...................................
Branch ........................................ Reference: .........................................................................................................................
CHECKED BY VERIFIED BY:
Signature .............................................
Name .................................................... ...................................................
Director/Chairman
Signature .............................................
Name ....................................................
Remarks........................................................................................................................................................................................................
DECLARATION
I) I_______________________________________________________ hereby certify & confirm that the information filled in the
Applications Form is complete and accurate in all respect, I understand and agree that misrepresentation of facts will justify
denial of admission/ cancellation of admission/ expulsion from the institute.
ii) If at any stage, it is found that I do not fulfill the minimum prescribed eligibility criteria of the University/Haryana Technical
Board, admission granted to me by the Institute can be cancelled and I will have no right/claim towards the Institution.
iii) I declare that information furnished by me in the application form is true in all respects and in case any entry or information is
found to be false, this shall result in automatic cancellation of my admission besides rendering me liable to such action as the
university may deem fit. I hereby undertake that I have carefully gone through the eligibility conditions prescribed in the
prospectus/website for the programme. I am applying for and shall appear in the entrance examination/direct counseling of
the Institute after satisfying myself that I do fulfill the same.
15. Applying for Hostel : YES/NO
(a) 10th ..........................................................
(c) ITI ............................................................
(e) SC/ST.......................................................
13. Detail of Guardian:
Name: ........................................................................................................... Relationship: ............................................
Address: .............................................................................................................................................................................
Contact Details: ...........................................................................Email ID:....................................................................
Guardian Annual Income:
Name: ........................................................................................................... Relationship: ............................................
Address: .............................................................................................................................................................................
Contact Details: ...........................................................................Email ID:...................................................................
14. In case of any emergency, who should be contacted:
(b) 10+2 ..........................................................
(d) Graduation .............................................
(f) Domicile ..................................................
16. Documents Attached (Equivalent to):