AMIRAJ COLLEGE OF ENGINEERING AND TECHNOLOGY

(Promoted by Amiraj Charitable Trust)

Nr. Tata Nano Plant,Village: Khoraj, Sarkhej-Viramgam.
Highway, Ahmedabad.
(02717294688, info@amirajcollege.in)

STUDENTS PROFILE:
1. STUDENTS BASIC INFORMATION
NAME: ___________________ _____________________________________ ____________________
(FIRST NAME)

(FATHERS NAME)

( SURNAME)

GENDER:
MALE/
FEMALE
LATEST COLOUR
PHOTOGRAHP
DATE OF BIRTH:
_ _ / _ _ / _ _ _ _ BLOOD GROUP: ________
WITH SIGNATURE
CASTE: GENERAL
OBC
SC
ST
OTHERS
RELEGION.______________________
PHYSICAL DISABILITY (If any): ________________________________
IDENTITY MARKS ON BODY:
________________________________
_________________________________
PRESENT ADDRESS:
____________________________________________________________
____________________________________________________________
____________________________________________________________
CITY: ____________________ PINCODE: __________________
PERMENENT ADDRESS: ____________________________________________________________
____________________________________________________________
____________________________________________________________
CITY: ______________________ PINCODE: __________________
CONTACT NO.S
HOME WITH STD CODE: _______ - _________________
MOBILE NO. OF STUDENT: _______________________
MOBILE NO. OF FATHER, ______________________________ PERSONS IN FAMILY.____________
MOBILE NO. OF MOTHER/SISTER/BROTHER
_________________________, ___________________________, ___________________________
ADMISSON CATEGORY MANAGEMENT QUOTA

OPEN
SC
NRI OPEN

ST
OBC
TFW

OTHER

2. STUDENTS EDUCATIONAL INFORMATION

ACPC MERIT NO: ___________ GUJCET MARKS: _______________ BOARD: _____________
12TH SCIENCE % (CPM): ______________ MEDIUM IN 12TH SCIENCE: __________________

12 TH
SCIENCE
1)
2)
3)
4)
5)
6)
11 TH
SCIENCE
1)
2)
3)
4)
5)
6)
1O TH
STANDA
-RD
1)
2)
3)
4)
5)
6)
7)

ACADAMIC PERFORMANCE RECORD

SUBJECTS
MARKS
NAME & ADRESS NAME OF PRINCIPAL
OBTAINED OF SCHOOL
AND HIS CONTACT NO.
/OUT OF

SUBJECTS
(THEORY)

MARKS
NAME & ADRESS NAME OF PRINCIPAL
OBTAINED
OF SCHOOL
AND HIS CONTACT NO.
/OUT OF

SUBJECTS
THEORY

MARKS
NAME & ADRESS NAME OF PRINCIPAL
OBTAINED
OF SCHOOL
AND HIS CONTACT NO.
/OUT OF

3. STUDENTS CORNER:
GAMES:CRICKET
VOLLEYBALL
FOOTBALL
CHESS
TENNIS
HOCKEY
KHO-KHO
SKEITING
KABDDI
OTHER: _________________ _________________

READING & CREATIVE CRAFTS:NOVEL

SCIENCE & TECHNOLOGY RELIGIOUS
PAINTING
WRITING POEMS
WRITING ARTICLE SELECTIVE
ARTICLE BY AUTHOR (MENTION NAME)
NAME OF AUTHOR: __________________________
NAME OF ARTICLE: __________________________
OTHERS:INNOVATIVE IMPLIMANTATION
SINGING MUSIC
MIMICRY
MARSHAL ARTS
KARRATE, OTHER ___________________ ___________________
SPECIAL ACHIEVEMENTS
NAME OF COMPITITION NAME OF ACTIVITY

LEVEL

RANK

4. STUDENTS FAMILY & PARENTS INFORMATION

FATHERS DETAIL

MOTHER/BROTHER SISTER/
DETAIL

NAME
QUALIFICATION
BLOOD GROUP
OCCUPATION
DESIGNATION
OFFICE ADDRESS
OFFICE CONTACT
NO.
YEARLY INCOME
CONTACT NO.
EMAIL ID
SIGNATURE
PHOTOGRAHPH
OF FATHER

PHOTOGRAHPH
OF
MOTHER/BROTHER/SISTER

5. EMERGENCY CONTACT DETAILS:

PERSON NO.1

PERSON NO.2

NAME
RELATION
ADDRESS

CONTACT NO.
6. WRITE 5 SENTENCES ABOUT YOUR AREA OF INTEREST:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
____________________________________________________________________________________
7. MY ROLE MODEL: ______________________________________________________________________
8. WRITE 5 SENTENCES ABOUT YOUR VISION.
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
_______________________________________________________________________________
STUDENTS SIGNATURE:________________________________ DATE;_______________________
PARENTS SIGNATURE :
FATHERS SIGNATURE: :________________________________
MOTHERS SIGNATURE: :________________________________