INDIRA GANDHI INSTITUTE OF TECHNOLOGY

SARANG DIST-DHENKANAL- 759 146

AUTONOMOUS INSTITUTE OF GOVT. OF ODISHA
TRAINING AND PLACEMENT
Students Profile Form
Branc!""""""""""""""" Colle#e Roll$No!""""""""""""""""
%ni&ersit'(Council Re#d$No!"""""""""""""""""""""""
DEGREE/DIPLOMA/MCA """"""""""""""""""""""
Affi) Latest Coloured
Pass*ort Si+e
Poto#ra* ere
Sl$No Item A**licants Profile
Personal Particulars
, Name(in block letter)
- Date of irt!
. "e# (M/$)
/ $at!er%s Name(in block letter)
0 $at!er%s Occu&ation
1 Cate'or((")*"C*OC*General)
2 Annual $amil( Income
3 Nati+e "tate
Aca,emic Particulars
4 -ear of Passin' ./
t!
"t, 0 name of t!e oar,
,5 1 of marks in ./
t!
,, -ear of Passin' I)I 1 name of t!e Council
,- -ear of &assin' .2
t!
0 name of t!e oar,
,. 1 of marks in I)I
,/ 1 of marks &assin' .2
t!
,0 Name of oar, in .2
t!
,1 -ear of &assin' Di&loma 0 name of t!e oar,/Council
1 of marks in Di&loma
,2 -ear of 3oinin' Colle'e in E/ 4)ec!/Di&loma/MCA
,3 $irst "emester
Pa#e6,
,4 "econ, "emester
-5 )!ir, "emester
-, $ourt! "emester
-- $ift! "emester
-. "i#t! "emester
-/ "e+ent! "emester
-0 Ei'!t "emester
7In case of Di*loma student te' are ad&ised to mention teir mar8s in *ercenta#e

Present )ec!nical 5ualification &articulars4
"GPA (6) CGPA(6)
Ot!er Information
-1 Permanent A,,ress
-2 Corres&on,ence A,,ress
-3 P!one No (mobile 0 lan,line) "tu,ent7
Parents7
Local Gur,ian7
-4 E mail
.5 E#tra Curricular Acti+ities
Declaration b( t!e A&&licant
I declare tat te details furnised are true to te 9est of m' 8no:led#e$
Place !""""""""""""""""
Date! """""""""""""""" Si#nature of te candidate in full
NB! i;$ Furnisin# :ron# information :ill attract disci*linar' action$
ii;$ Incom*lete 9io6data :ill 9e re<ected$
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