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M.TECH.

ADMISSION 2013 -14


PROFILE OF STUDENT
NAME (with Initials)

NAME (in Tamil with initial also in Tamil):


DATE OF BIRTH

SEX

MALE / FEMALE

RELIGION

ISLAM / HINDU / CHRISTIAN

COMMUNITY

OC / BC / MBC / DNC / SC / ST

NAME OF THE CASTE

: PHYSICALLY CHALLENGED: YES / NO

MOTHER TONGUE

: NATIONALITY:..

FATHERS NAME

FATHERS OCCUPATION

MONTHLY INCOME

COMMUNICATION ADDRESS :

:BLOOD GROUP:..
....
...
. PIN .
Stete:

PERMANENT ADDRESS

....
...
. PIN .
State:.

ORGANISATION ADDRESS

.. PIN

PHONE (WITH STD CODE)

OFF: ... RES: ..

E-MAIL ID

Parent Cell Phone No: ..


.

GUARDIAN NAME & ADDR.

.. PIN
PHONE NO:

SIGNATURE OF THE STUDENT

SIGNATURE OF THE PARENT

****

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