Registration Fee

General - ` 100/-
GOVERNMENT OF KARNATAKA
SC/ST/CAT-1 - ` 50/-
DIRECTORATE OF TECHNICAL EDUCATION
APPLICATION FORM FOR ON-LINE INTERACTIVE ADMISSION TO DIPLOMA COURSES FOR THE YEAR 2018 – 19

Before filling the application form, Please

1.SSLC or EQUIVALENT REGISTER No.
read the item – wise instructions as given in
the brochure

2. Name of the candidate

3. Date of Birth 4.Aadhaar No.

5. Name of the Father

6. Name of the Mother

7. Sex 8. Address
Male Female Name ………………………………………………………………………………………………
9. Telephone Number
a) Landline Address ……………………………………………………………………………………………

City ………………………………………………………………………………………………….
b) Mobile
State ………………………………………………………………………………………………..
c) E-mail
Pin Code

10. Indian Nationality 11. Religion 12. Qualifying Examination

YES NO SSLC CBSE ICSE
OTHER

13. Native State Code 14. Native District Code 15. Mother Tongue

16. Code of the State Appeared for SSLC / Equivalent 17. Code of the District Appeared for SSLC / Equivalent

18. Year of 19. Total Max 20. Total Marks 21. Percentage
Passing Marks in all Sub Obtained in all Sub
22. Marks in 23.Marks in 24.Total Max Marks in 25.Marks Obtained
Maths Science Science & Maths Science & Maths
26. No.of Years Studied 27. Claiming Exemption From Yes No 28. If YES Mention Clause Code
In Karnataka 5 Years Study Rule
29. Have you Rural Study yes No 30.SNQ Claiming yes No 31. Have you Kannada yes
No
(1st to 10th) Medium (1st to 10th)
32.Income 33. Category 34. Name of the Caste
35. Special Category Code
NCC JTS JOC HK EDP DP ITI Trade 37. AMOUNT PAID
GK PS SP SS PH AI CI 38. CHALLAN NO
36. 371(J) Hyderbad-Karnataka Claiming Yes NO 39. AMOUNT PAID DATE

DECLARATION 40. RECENT PASPORT SIZE COLOR

We declare that the above information is true and correct to the best of our knowledge PHOTO

Signature of Parent/Guardian Signature of the Candidate