29.

Please tick the appropriate box Registarion Fee

Engg Non Engg SC/ST/C-1 -50/-
GOVERNMENT OF KARNATAKA Others -100/-
DEPARTMENT OF TECHNICAL EDUCATION

APPLICATION FORM FOR ADMISSION TO DIPLOMA COURSES IN GOVERNMENT / AIDED

POLYTECHNICS FOR THE YEAR 2024-25

(Before filling the application form, Please read the item – wise instructions as given in the e-book)
To,

The Principal,

1. SATS NO. 2.Aadhar No.

3. Name of the candidate (in BLOCK LETTERS only)

4. Name of the Mother

5. Name of the Father

6. Date of Birth 7. Gender

D D M M Y Y Y Y Male Female Others

8. Indian Nationality Yes NO 9.Religion

28. PLEASE AFFIX YOUR
PASSPORT SIZE
10. Qualifying Examination 11.Code of the PHOTOGRAPH USING
(Please Tick the appropriate box) SSLC CBSE GUM. DO NOT USE
Native State
STAPLER OR PIN
12.If Karnataka, Code of
ICSE OTHERS the Native District

13. Code of the 14.Total No.of Years 15.Have you studied in 16.Have you studied in
Yes No Yes No
State appeared for Studied in rural areas from 1st to Kannada Medium from 1st
SSLC or equivalent Karnataka 10th Std to 10th Std

17.Do you claiming Yes No 18.If Yes, Mention Clause Yes No 20.Do you claiming Yes No
19.Do you claiming
exemption from 5 code (See instruction No.3 Hyd-Kar quota
SNQ quota benefit
years of study rule of the Genral Instructions benefit

NCC JTS JOC EDP DP PS SP SG PH AI CI HK GK ITI

21.Do you claiming Special Category
benefit, (Please Tick the appropriate box)
 24.Annual income of Parent's from
23.Name of the Caste all the sources
22. Reserved Category
Code which you belongs to

25.EDUCATIONAL PARTICULARS AND MARKS DETAILS

A) Register Number of SSLC Year of

or Equivalent Exam Passing

1) Total Max. Marks in all subjects Total Marks obtained

2) Max. Marks in Science Marks obtained

3) Max. Marks in Maths Marks obtained

Total Marks
4) Total Max. Marks in Science & Maths obtained in Science
& Maths

26.Student Mobile Number:

27.Full Postal Address (in BLOCK LETTERS only)

Parents Mobile Number:

PIN CODE

E-mail ID:

DECLARATION
We decalre that the above information is true and correct to the best our knowledge and belief. In case if any of
the above information is found to be false or incorrect, we shall forfeit the claim to be considered for a seat in a
polytechnic. In such an event, we will also be liable for civil and criminal action as the Government or the
Department of Technical Education may take action against us in this behalf. Also we abide by the rules existing at
the time of seat selection process.

Signature of the Candidate Signature of the Parent/Gardian

Date: Date:
 GOVERNMENT OF KARNATAKA
DEPARTMENT OF TECHNICAL EDUCATION
DIPLOMA ADMISSION 2024-25
OPTION ENTRY WORK SHEET
To,
The Principal,

PRIORITY INST.
COLLEGE NAME COURSE NAME
NUMBER CODE

Name and Signature of the Candidate

Note: Priority-1 will have high priority (preference)