GURUKULA KANGRI VISHWAVIDYALAYA, HARIDWAR

FACULTY OF ENGINEERING & TECHNOLOGY

Application form for Admission to B.Tech. I Year (2011-12)
Note:- The candidates are required to go through the instructions given in the information brochure before filling the form.

1. Name of the Candidate .................................................................................................

2. Father's Name...............................................................................................................

Cash Receipt/DD No. .....................

Dt. ...................Rs. ...................

3. Mother's Name.................................................................................................................
4. Date of Birth.....................................................................................................................
5. Nationality.........................................................................................................................
6. Permanent Address ........................................................................................................
..........................................................Pin...............................Phone.................................
7. Address for Correspondence ..........................................................................................

Affix a
Photograph of
passport size
attested by a
gazetted officer

..........................................................Pin...............................Phone...................................
8. Category : Please tick (
) the appropriate box (Attach a certificate for category B / C / D / E )
A (General)

B (OBC)

C (SC)

D (ST)

E (PWD )

9. Choice of Branch (write 1, 2, 3,4 in boxes in order of preference)

Computer Science
& Engg. (CSE)

Electronics & Communication

Engg. (E&CE)

Electrical
Engg. (EE)

Mechanical
Engg. (ME)

10. AIEEE-2011 Details (i) All India Rank.........................................................(ii) Roll No........................................

(Attach a copy of AIEEE-2010 Score Card)

11. Branch Alloted by CCB (If applicable).....................................................................................................................

12. Details of Examination Passed
Exam
Passed

Board/University

Year

Subjects Offered

Marks
Obtained

Maximum
Marks

% of
Marks

High School
Inter (10+2)
Declaration by the Candidate
I hereby declare that all the particulars stated in this application are true to the best of my knowledge and belief. I have read
the information brochure and the admission procedure and I shall abide by the terms and conditions therein. In the event of
suppression or distortion of any fact like Qualification, Nationality etc. made in my admission to GURUKULA KANGRI
VISHWAVIDYALAYA, HARIDWAR is liable for cancellation. I also understand that the decision of the authorities of GKV
regarding my admission will be final and I shall abide by their decision. Further, if admitted, I promise to abide by the rules and
regulations of the Vishwavidyalaya as applicable during the course of study. I am aware that ragging is banned in GKV and if,
found guilty, I shall be liable for punishment as per rules.

Place.........................

........................................................

...........................................

Date...........................

Countersigned by Parent/Guardian

Signature of the Candidate

(For office use only)

The eligibility conditions of the applicant have been verified and found O.K./not O.K.

Signature of the Assistant

Date ........................

GURUKULA KANGRI VISHWAVIDYALAYA, HARIDWAR

FACULTY OF ENGINEERING & TECHNOLOGY
Receipt of Application form for Admission to B.Tech. I Year (2011-2012)
Name of the Candidate...................................................................................................................................................
Enclosures.......................................................................................................................................................................................
The enclosures have been found/not found as per the list given above.
Date..................

Signature of the Assistant